East Hampton Village Board Has Questions about Proposed East End Health Plan

The East Hampton Village Board wasn't completely sold on the proposal for an East End Cooperative Health Plan Initiative, after it was presented to them on Thursday. Members of the board said they want to hear from participating doctors before deciding on whether to chip in over $4,000 on a costs and feasibility study.

Southampton Village Mayor Mark Epley, who is leading the initiative aimed at reforming health insurance for government workers and replacing the municipalities' dependence on Empire Blue Cross Blue Shield, paid a visit to East Hampton during a work session.

Along with J. Scott Bradley, a senior vice president at Cook, Hall & Hyde, Epley told the board municipalities and school districts would benefit from a "clinically integrated" network that will transfer paper records to electronic and allow patients to receive higher quality care which will create a more efficient system that will cut costs.

"If you look at issues associated with all of our budgets, one of the main issues is the retirement system and the health-care plans," Epley told the board. "Basically, every 5 or 6 years, our health-care costs are going to double."

The new insurance plan would be coupled with a health care method called the patient-centered medical home model, or PCMH, which calls for paying doctors more than an insurance company would, Epley has admitted. He said, however, the benefits municipalities receive in turn will ultimately result in savings.

But it was these increases that concerned East Hampton Deputy Mayor Barbara Borsack, who said she wanted to know specifically what kind of reimbursements the primary caregivers would receive. While Bradley could not give her any specifics at the meeting, Epley said,  "The answer to your question is the physician will be paid more."

Bradley told the board that physicians would be given more funding to provide higher quality care for their patients. Under PCMH, doctors and their staffs spend more time with patients in an out-patient setting to monitor their health better. For example, follow-up calls to patients to make sure they visited their specialists and were taking medications properly would be done under the new plan.

"Patient-centered medical home is nothing more than your physician's office, but once you walk in that office it's very different," he said. Physicians would be reimbursed, he said, to manage patients care at a higher level.

Borsack then asked, "How does that affect your specialists then?"

Bradley said the specialists are as important as the primary caregiver. He said that the primary caregivers and specialists would work together to reduce overall cost.

"I guess that doesn't really answer my question though," Borsack replied.

Borsack also said that one of her concerns were that she didn't want to make things more difficult for doctors who already have a hard time providing care on the East End because of the commute on Montauk Highway. "If it makes it more difficult for doctors to practice primary care, that's not a good thing for us," she said.

At the conclusion of the presentation, Mayor Paul Rickenbach Jr. said,  "We will certainly take this into consideration, but I think we have a lot to digest here." He asked Bradley and Epley to come to the next work session with medical professionals who would participate in the initiative.

Bradley said that physicans will be paid to oversee all of their patients' care that overall would cut down on medical errors, reduce emergency room visits, and improve patient outcomes which will be where the savings come in. "Physicians are very excited about these new models that are coming out," Bradley said.

A study of the plan would cost $8,750 for each town and approximately $4,375 per village, if all eligible towns and villages participate. 

To fund the start-up costs, the cooperative would compete for New York State Department of State Local Government Efficiency grants of up to $200,000 per municipality, with an aggregate cap of $1 million. A minimum of three municipalities and 2,000 members must sign-up before the state will sign off on a cooperative.

"I think it was a terrific meeting," Bradley said Friday. He said he thinks the board embraced the idea, but understandably had questions.

Epley and Bradley said they would return at the January work session, along with representatives of the East End Health Alliance and a local physician.

WITH REPORTING BY BRENDAN J. O'REILLY