Win Win: Aligning the New Mexico COOP Health Plan with Primary Care

By Stewart Gandolf
Chief Executive Officer

Dr. Martin Hickey, NMHC

Our podcast today is another in our series for the Physician Strategies Summit. In today’s interview, Healthcare Success Founding Partner Lonnie Hirsch talks with Martin Hickey, MD, CEO, New Mexico Health Connections, Albuquerque, NM.

As the Accountable Care Act (ACA) continues to unfold, it introduces new nonprofit health plans aimed at uninsured individuals and small businesses. New Mexico Health Connections (NMHC) is a patient-centered health plan alternative chartered by the ACA. It’s the first in New Mexico, and one of the first of its kind in the nation.

It’s also bringing us new vocabulary terms. “The exchange,” Dr. Hickey, NMHC CEO explains, “is like a ‘KAYAK’ of healthcare where qualified individuals and families can simply compare insurance plan benefits and costs, much as someone could compare travel details.” Potentially, there are 80-million people nationally that would qualify for the exchange.

The ACA also provides for the creation of not-for-profit Consumer Oriented and Operated Plans—commonly referred to as COOPs—to be governed by members of the plan, and mainly targeting uninsured individuals and small groups. NMHC is one of 24 COOPs in the nation (one in each of 24 states) with the aim of being less expensive, and with any profits being directed towards reducing premiums and improving benefits. In this podcast, Dr. Hickey discusses the ways in which NMHC differs from hospitals or large, shareholder-owned companies.

New Mexico Health Connections, which will begin enrollment in October of this year, has a primary care focus and is developing a strong partnership with Federally Qualified Health Centers and other primary care groups to manage risk and share Medical Loss Ratio savings with them.

In his Physician Strategies Summit presentation—and in our podcast today—Dr. Hickey explains the unique NMHC approach, a range of start-up challenges, and the priorities of keeping people healthy, lowering premium costs and delivering appropriate levels of care at the right time to keep patients out of unnecessary hospital stays.

Conference attendees will be able to explore, in greater detail, how this new approach is likely to unfold over the coming months and years as change continues to move from volume based healthcare to a value based system in America.

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Dr. Martin Hickey, MD, is Chief Executive Officer of New Mexico Health Connections. Before returning to New Mexico, he was a Managing Director of Navigant Consulting. He is a graduate of the Rush Medical College in Chicago. He also holds a master’s degree in Administrative Medicine from the University of Wisconsin, and completed a residency in Primary Care Internal Medicine at the University of Rochester.

Dr. Hickey is a Conference Co-Chair for the Forum for Healthcare Strategists’ Tenth National Physician Strategies Summit, Driving Performance and Value, to be held February 24-26 at JW Marriott Orlando Grande Lakes, Orlando, FL.

Stewart Gandolf
Chief Executive Officer at Healthcare Success
Stewart Gandolf, MBA, is Chief Executive Officer of Healthcare Success, one of the nation's leading healthcare and digital marketing agencies. Over the past 20 years, Stewart has marketed and consulted for over 1,000 healthcare clients, ranging from practices and hospitals to multi-billion dollar corporations. A frequent speaker, Stewart has shared his expertise at over 200 venues nationwide. As an author and expert resource, Stewart has also written for many leading industry publications, including the 21,000 subscriber Healthcare Success Insight blog. Stewart also co-authored, "Cash-Pay Healthcare: Start, Grow & Perfect Your Cash-Pay Healthcare Business." Stewart began his career with leading advertising agencies, including J. Walter Thompson, where he marketed Fortune 500 clients such as Wells Fargo and Bally's Total Fitness.



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