Cooper and AmeriHealth opt for narrow-network

May 1, 2013

The provider and payer will develop a suite of health plans and an accountable care model with fully insured, self-insured and Medicare products

Cooper University Health Care-a health system in southern New Jersey-has acquired a 20% interest in AmeriHealth New Jersey, an insurer that offers group and individual products. Together, the provider and payer will develop a suite of health plans and an accountable care model with fully insured, self-insured and Medicare products.

“We're not only going to be a 20% owner with option to buy more equity in the future, but we’re also working now to develop Cooper-centric narrow-network products,” says Eli Winkler, senior vice president for growth and development at Cooper University Health Care.

Cooper has more than 500 employed physicians in southern New Jersey and a network of more than 100 outpatient offices in 38 locations. Winkler says its system includes the only sophisticated academic tertiary care hospital in the area and the largest employed-physician group.

“The health plan product is going to be attractive,” he says. “It might have some gaps like all systems do, but AmeriHealth can help complete what we’re missing in our network. AmeriHealth has good contracts in place to round out our network.”

The first product could be ready to launch as early as 2014. It won’t necessarily be a health-insurance-exchange product, Winkler says.

Cooper will also incorporate a patient-centered medical home model in its primary care practices. It has experience in implementing the model for its own 9,100 employees.

AmeriHealth New Jersey is also one of five plans in New Jersey participating in the Centers for Medicare and Medicaid Services national comprehensive care initiative, which aims to develop a long-term primary care support plan in New Jersey. The pilot’s multi-payer approach offers incentives for physicians to alter their model of care and calls for greater collaboration and data aggregation.