By GREGORY N. HEIRES

DC 37 has worked closely with the city and EmblemHealth to create a new model for employee-based health and wellness coverage.

EmblemHealth’s new reimagined City of New York HMO Plan aims to offer a health care experience with affordable pricing and ease of use for city workers and their families.

One of the enhancements is the new Centers of Excellence program with ties to Hospital for Special Surgery, the top-ranked orthopedic hospital in the nation, and Memorial Sloan Kettering Cancer Center, one of the country’s leading cancer centers.

This program will begin on Jan. 1, 2019 for HIP HMO members.

Health Coaching

Participants in the HMO plan will continue to have access to all of their preventive and specialist benefits. They will be able to coordinate their care and appointments, receive personalized health coaching and care management, and access to the innovative Centers of Excellence support and care.

Customer service representative will be available to help plan members navigate through the health-care system and get the right care at the right time.

Participants will also have access to a new, state-of-the-art health outreach and education program through Care Management Solutions, Inc., an EmblemHealth affiliate. The program will offer participants personalized plans for staying healthy and managing their chronic conditions.

The HIP HMO changes will go into effect Jan. 1.

New programs and services that will be available to HIP HMO participants include:

The new Concierge Service (833-CNY-GOLD) is a helpline for NYC HIP HMO members only. The agents will help members navigate the health-care system.

• A voluntary wellness program will allow participants to complete an online Health Risk Assessment. The program includes personalized health coaching with a telephonic dedicated staff (lifestyle coaches and nurses) that will help members with asthma, COPD, heart disease and diabetes.
• Chronic Disease Management, a managed care program, will provide telephonic and field based-nurses for complex conditions, and
• Centers of Excellence will offer oncology and orthopedic care.

Other Highlights

• rewards and incentives for going for your annual wellness visit, getting needed health screenings and doing a Health Risk Assessment incentives for cost-effective care
• regular progress reports, and
• $0 cost-sharing for priority care at best-in-class hospitals for oncology and orthopedics.

This blog post is based on an article in the October 2018 issue of Public Employee Press, the official publication of District Council 37, AFSCME, which represents 125,000 public employees in New York City.