Pharmacy to Replace Mr Video III

TO: The SUNY Downstate Medical Center
Community

FROM: Grace Wong
Vice President for Managed Care and Clinical
Business

RE: Downstate’s
Contracts with New York Exchange Plans

As we all know, on January 1, 2014, the
New York Health Exchange plans went live. SUNY Downstate Medical Center is
currently contracted with ONLY four such plans — HealthFirst, Fidelis Care,
Affinity, and POMCO. Two other Health Exchange plans (Oscar and Health
Republic) do not have direct contracts with SUNY Downstate UHB, but are clients
of MagnaCare and will thus be accessing our services under our agreement with
MagnaCare.

It has come to my attention that there
is still some confusion regarding SUNY Downstate’s participation with health
plans that have enrollees in product lines developed specifically under the
federal Affordable Care Act.

Traditionally, when SUNY Downstate UHB
enters into a provider contract with an insurer, we participate in all product
lines of the health plan to mitigate confusion about plan participation.
However, these same health plans are asking for steep discounts to SUNY’s rates
for these “exchange products,” and our financial risk with respect to these new
products is compounded by the high co-pays and deductibles that these programs
require of enrollees who were formerly uninsured.

Therefore, it is simply not in SUNY
Downstate’s financial interest to participate with all the health plans that
have exchange programs. For example, we do not participate in MetroPlus Health
Plan’s “marketplace” plans for the reason stated above, but we are still in
their network for Medicaid, Family Health Plus, CHP, and Medicare Advantage
enrollees.

While we continue to have discussions
with plans that have “exchange” products that we are not participating providers
for, the fact remains that currently only those plans noted in the first
paragraph above are formally contracted with SUNY Downstate and UPB providers.
For all other NY “exchange” products — even if a “contracted plan” for
Medicaid or other lines of business (such as Emblem Health and Empire BCBS) —
SUNY Downstate does NOT have contracts to participate in their specific
exchange programs

They add flavor to medicine to make it more palatable.

Ah! Thank you. I was thinking that you buy a BPA-free baby bottle and they throw in some chocolate syrup, maybe a little seltzer…