North Shore-LIJ CEO Michael Dowling on value-based reimbursement, growing market share

CareConnect, a health insurance company created by New York City-based healthcare group North Shore-LIJ Health System last year, is building its performance-based reimbursement model--and its market share.

About 350,000 of its members are in value-based plans, a number that's expected to grow. 

Michael Dowling, CEO of the healthcare system, shared his insights regarding the payment method with Crain's New York Business.

"The revenue in healthcare is changing, and you've got to diversify. I'm a big advocate that we should get paid for value and get away from traditional fee-for-service," he said in the interview.

Recent reports call for the need to speed up the adoption of VBR so the entire healthcare industry can implement systems-engineering principles that will boost efficiency of care, according to a report from the President's Count of Advisors on Science and Technology, FierceHealthPayer previously reported.

Dowling says moving quickly on VBR could help hospitals that are struggling financially.

While 90 percent of payers and 81 percent of hospitals already implement a mix of value-based reimbursement and fee-for-service, payers expect FFS to decrease from 56 percent to 32 percent in five years, while hospitals anticipate a decrease from 57 percent to 34 percent, FierceHealthPayer previously reported.

Dowling also explained why his organization is expanding into new markets and why it covers care outside its own network. A bigger network, he said, builds stronger relationships and can help stave off unwanted competition from those in other markets who are also looking to expand.  

For more:
- read the interview

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