A Healthy Vision

by Rich Argentieri, SVP and Chief Sales & Marketing Officer

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.