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Health Plan Profile: EmblemHealth

EmblemHealth: New York’s Health and Wellness Company

For more than 75 years, EmblemHealth has been putting care first — for our members and the communities we serve. We are innovators in developing new programs and resources that result in improved care coordination, better health outcomes, higher member satisfaction and lower health care costs. As a customer-focused company, EmblemHealth is committed to providing access to quality care and value to approximately 3.4 million people. We are building networks that offer an efficient, patient-centered model of care — most notably AdvantageCare Physicians, a community-based, physician-led practice. By measuring, monitoring and improving the clinical care our members receive, we provide programs, tools and resources to help them stay healthy, get well and live better.

In 2013, EmblemHealth’s commitment to quality earned accolades from leading national organizations, including the rating of four stars for our Medicare HMO from the Centers for Medicare and Medicaid Services — the highest of any Medicare Advantage HMO in the New York City region. Other honors from URAC and the New York Department of Health confirm that our focus on continuous quality improvement continues to move EmblemHealth in the right direction.

EmblemHealth has always been an integral part of the New York community. We’ve built on that foundation by increasing our presence in the neighborhoods we serve and engaging with our members where they live. In Harlem, Cambria Heights, Queens and Chinatown, members and local residents can meet with a health care expert at EmblemHealth Neighborhood Care (EHNC) to ask questions, get reliable information and have problems solved.  By putting care first, EmblemHealth is achieving quality, sustainable health care. That is and always has been our mission because EmblemHealth is more than just a health insurer — we are New York’s health and wellness company.

Preventing Diabetes and Improving Health

In keeping with its  mission to improve the overall health in the communities that it serves, EmblemHealth launched the CDC’s Diabetes Prevention Program (DPP) at its Neighborhood Care locations in Harlem and Cambria Heights in July, 2013. EHNC is a unique approach to solving the challenges of health care and is open to the community, providing a space for the community to:

  • Ask questions about benefits
  • Look for ways to lower out-of-pocket costs
  • Resolve billing issues
  • Find a doctor who meets their needs
  • Join health and wellness programs
  • Connect to community support and find a health plan that’s right — and more

The sites for Neighborhood Care were selected based on factors such as the number of members living in the areas and health disparities — including the rate of obesity and prevalence of diabetes. For example, the percentage of EmblemHealth members diagnosed with diabetes in Harlem is 14.9 percent and 14.1 percent in Cambria Heights.

EmblemHealth has a multi-modal recruitment and enrollment process for the DPP: member identification has and will continue to be conducted using claims data, provider referral and self-referral — as well as EHNC promotion of the CDC Prediabetes Screening Test, EHNC health risk survey referral and Disease Management and Case Management program referrals.

One full-time diabetes prevention specialist and data analyst oversees the implementation and the ongoing scaling of DPP classes within EmblemHealth. Two full-time and two part-time certified lifestyle coaches facilitate the DPP lifestyle change program and EmblemHealth is currently expanding their lifestyle coaching staff. These coaches are able to provide a high touch focus that maximizes engagement. One of these two coaches will offer the class in Spanish.

EmblemHealth’s Marketing & Communications Department has been involved with this initiative from the beginning. The team has  assisted in the development of all physician and patient communications — ensuring a clear, consistent and accurate description of the program to both providers and individuals who may qualify for the program. For the initial launch, EmblemHealth outreached to over a thousand members via phone calls, physician referrals and mailings.

Results to Date

  • In the initial set of classes in year one, participants ranged in age from 36 to 87 years with an average age of 65 years. The majority of classes were primarily comprised of African- American and black women.
  • The average weight loss in year one was seven pounds in all participants. All participants reported an increase in their activity minutes.
  • EmblemHealth has hosted 17 classes with 183 participants enrolled.
  • Additional metrics collected, including A1C’s and blood pressure, are trending downward.
  • EmblemHealth saw a 50 percent decrease in hemoglobin A1C at week 16 for all participants.
  • The program boasts an 86.5 percent completion rate for the first graduating classes.

Scaling and Sustaining the Program
EmblemHealth is currently enrolling participants in EHNC Harlem and in Cambria Heights on an ongoing basis. In addition, one class is anticipated to launch at an AdvantageCare Physicians, one of the largest physician-led practices in the New York metropolitan area, medical office in summer 2014. EmblemHealth, along with all of the health plans participating in the cooperative agreement, submitted their initial six months of data to the CDC in early 2014.

EmblemHealth is committed to continue scaling the National Diabetes Prevention Program. In addition to continuous class offerings at EHNC Harlem and Cambria Heights, conversations with EmblemHealth’s Human Resource department have begun to deliver the program onsite to employees and, EmblemHealth’s Sales department is exploring offering the DPP to other employer groups. EmblemHealth continues meeting with the New York State Department of Health to identify opportunities for collaborating and scaling the program to more participants in New York City.