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PEP Oct 2014
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Public Employee Press

Emblem Health opens network of centers
"The centers offer the convenience of basic health care under one roof. It's like one-stop shopping."
—Henry Garrido, DC 37 Associate Director

By GREGORY N. HEIRES


Emblem Health is encouraging DC 37 members and retirees enrolled in its HIP and GHI insurance plans to consider getting their health-care services through a new innovative network of centers that opened over the past year in the metropolitan areas.

Recently, Emblem Health sent out an information packet to members and retirees who live nearby the centers, which offer comprehensive medical services.

Municipal unions are working with EmblemHealth to publicize the health insurance company's AdvantageCare Physicians program. Retirees enrolled in Medicare are not eligible.

The collaborative effort came about because of this year's agreement between municipal unions and the city to search for more than $3.4 billion in heath-care savings over the next four years.

The agreement opened the way for Mayor Bill de Blasio to negotiate new eco-nomic agreements with virtually all of the more than 300 municipal unions in the city - including DC 37 - whose members worked for years without a contract under his predecessor. The health-care savings agreement enables the unions to continue to receive their medical coverage without being forced to contribute a premium.

"For decades the unions have sacrificed higher wage increases to be able to receive affordable health-care coverage, so we believe our anti-government and anti-union critics who charge we unjustly have a so-called ‘Cadillac' health plan are deceitful and politically dishonest," DC 37 Executive Lillian Roberts said.

"Our willingness to work with the city to try to find ways to meet the $3.4 billion savings target through programs like AdvantageCare Physicians points to our dedication to make the city's health-care program more efficient while meeting the needs of our members and retirees," Roberts said. "Quite frankly, I think what we are doing should serve as a model for municipalities around the country that are trying to cope with broken and inefficient health-care systems that have vast administrative waste."

Comprehensive services

By putting many services under a single roof and assigning a primary-care physician to oversee treatment of patients, the new program aims to improve the efficiency of health-care services.

The AdvantageCare Physicians program brings together more than 400 primary physicians and specialists and 2,300 nurses, medical assistants and other staff at 36 centers in New York City and Nassau and Suffolk counties. EmblemHealth aims to open additional centers in the metropolitan area.

The centers provide patients with coordinated care and access to com-prehensive services. The centers are not structured to handle life-threatening emergencies, but they do treat patients needing immediate care for injuries such as bone fractures, broken noses, dog bites and lacerations requiring stitches.

The health-care coverage offered by the centers includes preventive and specialty care, as well as pharmacy, laboratory, X-ray, pediatric and social work services. The centers also have health and wellness programs and medical screenings.

Many locations are open on the weekend and in the evening for routine care, and some centers remain open on the weekend for emergency services. Certain locations have same-day appointments with primary care physicians, including pediatricians. The program's specialists are affiliated with most of the area's leading hospitals.

"I like to describe AdvantageCare Physicians as offering one-stop shopping," said DC 37 Associate Director Henry Garrido, who recently visited some ACP centers.

"We want to be clear that the program isn't for everyone, especially folks have who would feel very uncomfortable about leaving a doctor they have seen for years," Garrido said. "But ACP should be especially attractive to people who don't have a regular doctor and others who are in good health or not seeing a specialist."

Willie Chang, director of health planning at the DC 37 Health & Security Plan, stressed that the program is voluntary. Chang is the chair of the health-care benefits subcommittee of the Municipal Labor Committee, which represents city unions on health matters.

Chang explained that the enrollment procedure differs for members and retirees in HIP and those who are covered by GHI.

GHI is based on the preferred-provider model of health care in which subscribers are able to arrange for their own appointments with in-network physicians and specialists and only have to worry about meeting the $15 and $20 respective co-pays of those providers. To use ACP services, GHI subscribers simply need to choose a center that is most convenient and addresses their needs, Chang said.

On the other hand, HIP is based on the gatekeeper HMO health-care model. HIP subscribers must therefore sign up with a primary-care physician, who will be in charge of monitoring their overall care and referring them to specialists, Chang said. HIP will give subscribers a new ID when they sign up for a center.

Lots of specialists

"If you are a HIP enrollee, you must be willing to change your primary-care physician," Chang explained. "HIP will then assign you to a new primary-care physician. You will be allowed to keep your specialists if that's your desire. But if you are dedicated to your current primary-care physician this might not be a good option for you."

To become an AdvantageCare Physicians patient, call 1-718-MYACPNY (1-718-692-2769). You can visit www.acpny.com for more information and to find the center closest to your home.

ACP primary care services include family practice, internal medicine, obstetrics and gynecology and pediatrics.

Specialty care includes general surgery, allergy and immunology, cardiology, endocrinology, neurology, nutrition, oncology, orthopedics, ophthalmology, physical therapy and rehabilitation, pulmonary medicine, radiology, rheu-matology, urology and other services.



 
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