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Case Studies

Union Health Center: The Premier 32BJ Health Fund 5 Star Center

Case Studies

Total Joint Replacement: Partnering to Reduce Costs and Boost Quality

Case Studies

32BJ Health Fund Fights High Hospital Prices at New York Hospitals
Like other healthcare purchasers, the 32BJ Health Fund is not immune to the forces causing healthcare prices to rise. What’s different is the way the Health Fund responds. Many payers choose to raise premiums, copays, deductibles, and other out-of-pocket expenses—and shift more of the financial responsibility from employers to employees. The Health Fund does everything possible to avoid taking such action because we know that high prices can be a barrier to treatment for our members. In an effort to control our expenditures, we developed a robust data analytics team to analyze the millions of rows of claims data we receive from our partners and vendors. The findings revealed major variations in the prices we pay for standard, high-volume procedures at New York City hospitals. For example, the Health Fund paid more than $80,000 for hip replacement surgery at one hospital, as opposed to a median price of $53,000 elsewhere. There were similar price disparities for having a baby, knee replacements, and many other kinds of inpatient and outpatient care, but there was no evidence of quality differences to support the higher prices.

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Hospital Prices: the Policy and the Practical

The 32BJ Health Fund prepared a compendium of state and federal policy interventions to address hospital pricing.

This important reference tool outlines the opportunities and challenges for each solution—with three clear takeaways:

  1. There is no one perfect solution to solve the issue of high hospital prices and healthcare costs.
  2. It is possible to lower hospital prices while preserving affordability and access to high-quality providers, and it is happening all over the country.
  3. New York was notably absent from the states that are actively engaged in tackling the issue of high hospital prices.

 

The 32BJ Health Fund believes that it can find a path forward for equitable and sustainable solutions that tackle the problem of high hospital prices.

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Hospital Prices: Unsustainable and Unjustifiable

The Health Fund has published a report of its claims data analysis and other publicly available information and found that it was charged $1.1 billion above Medicare prices from 2016 to 2019. 

The leading driver of these costs is the skyrocketing price of hospital care, especially in the New York City market. 

Unless dramatic action is taken to rein in hospital pricing, access to affordable care for the Fund’s plan participants, as well as millions of others who depend on hospitals to provide critical care, is in jeopardy. 

In this report, the Health Fund identifies where hospital prices are highest and how they impact its plan participants. The Fund also addresses some of the most common misconceptions about hospital prices and identify policy interventions that have proved effective in various locations around the country.

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Hospital Prices: the Policy and the Practical

The 32BJ Health Fund prepared a compendium of state and federal policy interventions to address hospital pricing.

This important reference tool outlines the opportunities and challenges for each solution—with three clear takeaways:

  1. There is no one perfect solution to solve the issue of high hospital prices and healthcare costs.
  2. It is possible to lower hospital prices while preserving affordability and access to high-quality providers, and it is happening all over the country.
  3. New York was notably absent from the states that are actively engaged in tackling the issue of high hospital prices.

 

The 32BJ Health Fund believes that it can find a path forward for equitable and sustainable solutions that tackle the problem of high hospital prices.

HP-Policy-Practical_print-digital-cover

Hospital Prices: Unsustainable and Unjustifiable

The Health Fund has published a report of its claims data analysis and other publicly available information and found that it was charged $1.1 billion above Medicare prices from 2016 to 2019. 

The leading driver of these costs is the skyrocketing price of hospital care, especially in the New York City market. 

Unless dramatic action is taken to rein in hospital pricing, access to affordable care for the Fund’s plan participants, as well as millions of others who depend on hospitals to provide critical care, is in jeopardy. 

In this report, the Health Fund identifies where hospital prices are highest and how they impact its plan participants. The Fund also addresses some of the most common misconceptions about hospital prices and identify policy interventions that have proved effective in various locations around the country.

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Case study Highlights

Union Health Center: The Premier 32BJ Health Fund 5 Star Center

The Union Health Center (UHC) traces its founding to 1914 by the International Ladies’ Garment Workers’ Union (ILGWU) to provide healthcare to its members. Today, UHC continues to prioritize caring for the health and well-being of working people—including 32BJ members and their families. In 2012, the 32BJ Health Fund partnered with UHC to establish its 5 Star Center model where plan participants pay a $0 copay. As the Health Fund expanded the model across several states, UHC remains its flagship center. Most 5 Star Centers are recognized as Patient-Centered Medical Home Model (PCMH) Level III by the National Committee of Quality Assurance (NCQA). 

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Total Joint Replacement: Partnering to Reduce Costs and Boost Quality

The 32BJ Health Fund used claims data to identify Mount Sinai Health System, and in 2016, the Health Fund contracted directly with Mount Sinai to reduce the cost and improve the quality of total joint replacement (TJR) surgeries. In January 2022, the Health Fund added specialty hospitals in five more states to establish the 32BJ Health Fund Centers of Excellence (COE) for Joint Replacement and Weight Loss (Bariatric) Surgery. Participants have a $0 copay for their surgery and specific follow-up care. Moreover, 100 percent of program participants say they are satisfied with the results of their care, and 97 percent would recommend the program to a friend.

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FAQs

Members pay $0 premiums, $0 deductibles, and $0 copays for many preferred providers, and low copays for other providers.

The Health Fund assesses provider performance and incentivizes high-value care that keeps costs low. For example, the 32BJ Health Fund saves millions of dollars through its use of the Centers of Excellence and innovative benefit plan design.

Many employers struggle to maintain health benefits without shifting more costs to employees each year. The management and union trustees of the 32BJ Health Fund emphasize controlling total costs for both employers and employees. Successes include:

  • Below trend increases in employer contributions year after year
  • Flat prescription drug costs in an environment of great increases
  • Millions of dollars saved through Centers of Excellence and benefit plan design

91 percent of the Health Fund’s members say that they are satisfied with their insurance, and 88 percent of members trust the Health Fund to recommend programs to them.