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Collaborations & Initiatives 2017-03-10T18:24:49+00:00

Collaborations & Initiatives

The New York Health Plan Association (HPA) regularly teams with physicians, hospitals and other providers, as well as legislators, regulators and consumers on joint initiatives. These joint efforts are designed to improve the quality of health care being delivered to New Yorkers, facilitate the communication of information to all parties, and enhance New York’s health care system for all. Current HPA Initiatives include:

Health Information Xchange of New York (HIXNY)

A joint venture involving the HPA and the Iroquois Healthcare Alliance to establish a technology infrastructure to enable physicians, hospitals and payers to share information and resources and to conduct business using a standardized approach.

Health Information Xchange of New York (Hixny)The Health Information Xchange of New York (HIXNY) was jointly created by the New York Health Plan Association (HPA) representing 30 health plans statewide and the Iroquois Healthcare Alliance (IHA) on behalf of its 59 hospitals, to promote collaboration among providers and payers to reduce health care costs and promote high quality clinical care in upstate New York.

Created through a unique collaboration of health care providers and insurers, HIXNY will achieve this dual mission by providing a technology infrastructure and services to enable physicians, hospitals and other health care providers and insurers to interact, share information resources, and conduct business using a standardized, HIPAA compliant approach to administrative transactions. Originally organized in 1999, the initial efforts of HIXNY involved evaluation of a community web portal for electronic claims transactions and organization of a workgroup of hospitals and health plans to develop mutually agreed upon regional HIPAA transaction standards. In recognition of the growing momentum at the federal and state levels for development and implementation of Health Information Technology (HIT) to improve the quality of health care and reduce health care costs, HIXNY has begun work to create a clinical data exchange to advance HIT standardization and interoperability.

Health Care Fraud

A statewide campaign to educate consumers about the cost and impact of health insurance fraud, and to enlist consumers in the fight to report and reduce fraud.

The cost of health insurance fraud and abuse is estimated to be as much as $54 billion dollars each year. Efforts to identify and report fraud can save tens of millions of dollars. That’s why New York’s health insurers, working with the New York Health Plan Association and the National Health Care Anti-Fraud Association, are joining together in a campaign to educate the public about fraud and its costs and to get consumers involved in the effort to reduce fraud.

What is Fraud?

Fraud is stealing, which is a crime, and it is a crime that affects everyone. When people commit health care fraud crimes, those actions contribute to rising costs of health care. Reducing health care fraud and abuse can help contain rising health care costs.

What is Considered Health Care Fraud?

The most common kind of fraud involves a false statement, misrepresentation or deliberate omission that is critical to the determination of benefits payable. The most common examples of health care fraud include, but are not limited to:

  • Billing for services, procedures and/or supplies that were not provided.
  • Ordering services that are unnecessary or unwarranted for the purpose of financial gain.
  • The intentional misrepresentation of any of the following for purposes of manipulating the benefits payable:
  • The nature of services, procedures and/or supplies provided.
  • The dates on which the services and/or treatments were rendered.
  • The medical record of service and/or treatment provided.
  • The condition treated or diagnosis made.
  • The charges or reimbursement for services, procedures, and/or supplies provided.
  • The identity of the provider or the recipient of services, procedures and/or supplies.

By its nature, health care fraud revolves around the exploitation of patients and their health insurance information, and as such, it involves much more than financial loss. Fraud also involved the creation of false medical histories for the persons in whose names those false claims are filed. Depending on the nature of the fraud, some providers put patients at physical risk solely for the purpose of generating falsified claims.

What Can Consumers Do to Fight Health Care Fraud?

Consumers can take the following simple steps to help reduce fraud and abuse:

  • Examine medical bills closely to verify services.
  • Ask for explanations or clarification of any unusual or questionable services.
  • Call your health insurance company to report any suspicious activities.

The following websites offer more information about fraud and what you can do to help prevent it:

New York Anti-Fraud Campaign

Since 2000, HPA and several member plans have partnered with the National Health Care Anti-Fraud Association to run a series of radio and print ads throughout New York State aimed at alerting the public to be aware of health care fraud in an effort to increase detection and prevention. These ads run twice yearly.

Get a PDF copy of the current Anti-Fraud ad:

Download Anti-Fraud Ad

New York State Prevention Agenda

The New York Health Plan Association is one of more than 140 organizations supporting the New York State Prevention Agenda. The Prevention Agenda 2013-17 serves as a blueprint for state and local action to improve the health of New Yorkers in five priority areas and to reduce health disparities for racial, ethnic, disability, socioconomic and other groups who experience them.

New York State Prevention Agenda 2013-2017The New York State Prevention Agenda is a 5-year effort to make New York the healthiest state. From promoting healthier food options, to maintaining safe streets that prevent falls and injuries, to reducing teen pregnancy, everyone has a role to play in making our communities and families healthier.

The Prevention Agenda 2013-17 is the blueprint for state and local action to improve the health of New Yorkers in five priority areas and to reduce health disparities for racial, ethnic, disability, socioeconomic and other groups who experience them. The five priorities are:

  • Prevent chronic diseases
  • Promote a healthy and safe environment
  • Promote the health of women, infants and children
  • Promote mental health and prevent substance abuse
  • Prevent HIV, sexually transmitted diseases, vaccine-preventable diseases and healthcare-associated infections

In addition to identifying New York’s most urgent health concerns, the Prevention Agenda also suggests ways local health departments, hospitals and partners from health, business, education and community organizations can work together to solve them. The New York Health Plan Association is one of more than 140 organizations that collaborated to develop the plan.

New York State Cancer Consortium

The New York State Cancer Consortium (NYSCC) is a network of individuals and organizations—including the New York Health Plan Association—that collaborate to address the cancer burden in New York State. The NYS Comprehensive Cancer Control Plan 2012-2017, which outlines objectives and suggested strategies to reduce the burden of cancer in NYS, serves as a guide for the NYSCC and its members.

The New York State Cancer Consortium (NYSCC) is a network of individuals and organizations—including the New York Health Plan Association—that collaborate to address the cancer burden in New York State. The NYS Comprehensive Cancer Control Plan 2012-2017, which outlines objectives and suggested strategies to reduce the burden of cancer in NYS, serves as a guide for the NYSCC and its members.

Cancer is the second leading cause of death in New York State. Nearly 35,000 New Yorkers die each year from cancer and more than 100,000 cases newly diagnosed each year.  Through the NYSCC, government, health care providers, advocacy groups and other stakeholders collaborate to address the burden of cancer across the continuum of cancer care, from prevention and early detection to treatment and quality of life issues.

In august, the NYSCC launched the New York State Comprehensive Cancer Control Dashboard, and interactive, web-based tool that helps monitor progress of cancer prevention and control efforts on 24 health promotion, cancer prevention and early detection indicators in NYS. The dashboard is also guides organizations working toward cancer prevention and control to areas most in need of intervention.