Pay BillWinter 2026 Insight Employer Newsletter
Five-Star Ratings: Why they matter
Last fall, Independent Health announced that we had achieved a 5-Star Rating for our commercial line of business from the National Committee for Quality Assurance (NCQA), as well as a 5-Star rating from the Centers for Medicare and Medicaid Services for our Medicare HMO plans.
Our overall ratings are due to top performance in areas like cancer screenings, diabetes care, and minimizing readmissions, to name a few. The ratings are a quick way to indicate high quality, but the significance and impact of the rating is so much greater and longer term.
Here’s why:
- If breast cancer is found very early, the overall 5-year relative survival rate is 99%. The overall relative 5-year survival rate drops to 32% for cancer that has spread to distant parts of the body.
- About 10 percent of adult New Yorkers has diabetes, with complications that include other serious conditions such as heart disease, stroke, chronic kidney disease, blindness and amputations.
- About $1 out of every $4 spent on health care in the US is spent on caring for people with diabetes, and 48% to 64% of lifetime medical costs for a person with diabetes are for the related complications.
- A 2024 study estimated that the average cost of a readmission to a hospital within 30 days of discharge costs $16,000. Focusing on post-hospital discharge planning improves the chance of recovery, reduces the length of inpatient hospital stays, and helps promote better outcomes while also reducing potential unnecessary expense.
It is for reasons like these that Independent Health focuses on preventive services so our members can stay healthy, and when a preventive service uncovers an issue, we help our members get the care they need. And it’s why we’ve earned a 5-star rating for three consecutive years. In fact, we are the only plan in New York State, and one of just eight across the country to earn 5 stars in 2025 from NCQA.
It’s our member-centric approach to our programs, processes and services, as well as our provider alignment and engagement approach. Our efforts and initiatives are extensive.
We have a best-in-class analytics team, tools and integrated data sets which are key to identifying the right issues and solutions accordingly. These pieces are put together to develop a 360-degree view of not only each member, but a comprehensive assessment of our entire membership to develop population health strategies.
Using data analytics, we identify which members need evidence-based preventive services, everything from immunizations to preventive cancer screenings to prenatal care. We develop personalized Member Action Plans for members, and outreach to those members, based on their communication preferences. At the same time, we provide our primary care physician practices information about their patients’ gaps in care to help them focus on their patients who need these important services. This has resulted in improved cancer screenings and immunizations.
Our internal clinical teams work closely to provide case management services to our members who may be struggling with chronic conditions, as well as those who need high-touch prenatal and post-partum services.
We have innovators tasked with developing programs with our hospital partners to ease the transition from the hospital to an alternative level of care, which has kept our members from backsliding and requiring readmission.
Supporting all of this is our quality management approach, which involves a multitude of processes, strategies, resources and people all focused on providing a better care experience for our members. In order to address gaps and strains in the health care system, Independent Health is working within the system and with our members to personalize care experiences. By creating greater efficiencies and a better overall experience, we have a better opportunity to address conditions before they occur, which translate into delivering better health trends, because receiving the right care, at the right time, and in the right setting leads to lower costs.
By Richard Argentieri, Senior Vice President, Chief Sales & Marketing Officer
Independent Health and MVP Health Care Affiliation Update
Last November, Independent Health announced that it will be joining the MVP Health Care family of companies, pending regulatory approval by New York State and federal agencies.
The planned affiliation is currently in the regulatory review phase, which we expect to be completed in the fourth quarter of this year. During this time, both Independent Health and MVP must continue to operate independently as the New York State Department of Financial Services and Department of Health and the Federal Trade Commission conduct their regulatory review.
Our pending affiliation will have no effect on our plan and product offerings for 2027, since we will be filing our 2027 products well before the affiliation is approved. Any changes we make to our plans or benefits in 2027 will be the result of our standard internal and operational assessments that we do each year in order to make sure our product offerings meet our employers’ and members’ needs.
Nevertheless, while both organizations are operating separately as we await regulatory approval, preliminary planning is underway to ensure a seamless transition once regulators approve the affiliation and the transaction closes.
This planning work has been collaborative, and it’s evident a cultural alignment exists between our organizations, as well as complementary capabilities. Rather than focusing on consolidation for efficiency (as we’ve seen in the other affiliations), our affiliation is about aligning strengths. Our approach prioritizes innovation, local trust, and building capabilities for the future.
Independent Health is committed to making sure our community-focused mission stays intact and that the decisions that matter most to Western New York continue to be made here, by people who know this region.
Independent Health will continue to communicate notable updates about our affiliation. In the meantime, contact your account manager with any questions.
COBRA Qualifying events and eligibility duration
The Consolidated Omnibus Budget Recovery Act of 1985, Federal Public Law 99-272, Title X (COBRA) requires most employers to provide the option of continued coverage to “qualified beneficiaries” who would otherwise lose health care benefits because of a qualifying event.
Qualified beneficiaries are individuals covered under a group health plan maintained by the employer of a covered employee by virtue of being the:
Covered employee, spouse of the covered employee or dependent child of the covered employee.
These individuals must be covered on the day before the qualifying event in order to be eligible for COBRA. The following is a brief description of some of the highlights of COBRA.
A qualifying event is any one of the following events that would result in the loss of health insurance coverage:
- The death of the covered employee.
- The termination (other than for reasons of gross misconduct) of a covered employee’s employment.
- A reduction in a covered employee's hours of employment. Reduction in hours includes a strike, layoff or a leave of absence, or as defined by the plan.
- The divorce or legal separation of a covered employee from the employee’s spouse.
- A covered employee becoming entitled to Medicare benefits.
- A dependent child ceasing to be a dependent child of the covered employee under the terms of the group health plan.
- With respect to certain retirees and their dependents, bankruptcy proceedings of an employer under Title 11 of the U.S. Code, commencing on or after July 1, 1986.
Qualifying Event |
Qualified Beneficiary |
Duration of Eligibility |
|---|---|---|
Termination, reduced hours |
Employee, spouse, or dependent child |
36 months |
Employee entitlement to Medicare, divorce or legal separation, death of covered employee |
Spouse or dependent child |
36 months |
Employee Death |
Spouse or dependent child |
36 months |
Divorce or legal separation |
Spouse |
36 months |
Loss of dependent child status under the plan rules |
Dependent |
36 months |
This summary is not intended to be a legal analysis upon which you can rely for a definitive explanation of the statute. Independent Health recommends that you contact your legal advisor and accountant to advise you of the applicability of the law to your group and the provisions and penalties for noncompliance.
Additional general information about COBRA, including a helpful Q&A, is available on the NYSDFS website.
Regulatory Notes: RxDC Reporting Coming Up; Privacy Notice Updates, and other updates
Prescription Drug Data Collection (RxDC)
It’s that time of year again for employers to help Independent Health comply with a reporting requirement on prescription drug and health care spending.
Under Section 204 (of Title II, Division BB) of the Consolidated Appropriations Act, 2021 (CAA), insurance companies and employer-based health plans must submit information about prescription drugs and health care spending. This data submission is called the RxDC report.
Independent Health must submit employer medical plan premium contribution information to the Centers for Medicare & Medicaid Services (CMS) on behalf of fully insured employer groups that offered our plans on an annual basis.
Employer premium contribution information is required to be submitted for the 2025 calendar year. In order for Independent Health to comply with these reporting requirements, we will be contacting our groups for specific information. Employers must provide us with their employer contribution portion of Independent Health’s medical plan coverage for calendar year 2025 as an average percentage.
We will be contacting our fully insured groups in early March; groups may want to begin to gather their information now in order to be able to submit the required documentation by April 10, 2026.
MCO Tax remains in place for 2026
New York State imposed a managed care organization provider tax, known as the MCO Tax, on commercial products beginning in 2025, designed to secure additional federal funding for NYS. Previously the Federal government signaled an end to the tax at the end of March 2026; however, the final rule enables New York to continue the tax through the end of this year. The tax is incorporated into the monthly premium.
Privacy Notice update
Independent Health has updated relevant privacy, security, and data handling policies to incorporate the recent regulatory changes under 42 CFR Part 2. While Independent Health does not operate as a “Part 2 Program” and does not provide direct Substance Use Disorder (SUD) treatment services, in limited circumstances we may receive SUD-related information originating from a Part 2 Program or another covered entity. Generally, Independent Health has not historically redisclosed SUD-related information except in certain, very limited circumstances permitted under law. We are updating our Notice of Privacy Practices to incorporate the regulatory changes.
Insight Newsletter Archive:
Check your billing invoices
Most employer groups’ anniversary date is January 1, so it’s good idea to make sure all or your changes for January have been made. Given the timing of changes needed for the January open enrollment, your January bill may not include enrollment changes submitted later. The February bill should show all of your January enrollments. If not, contact your account manager.