Northwell Contract Negotiations
Affordable Healthcare for New York City
What you need to know about EmblemHealth and Northwell's Negotiations
Northwell’s Prices Are Out of Step with Market Benchmarks
- New York hospital prices are among the nation’s highest, with commercial payments >300% of Medicare in 2022; the U.S. average was 254%.
- Purchaser evidence points to Northwell’s extreme outliers: system around 342% of Medicare and a facility at ~615% — pricing levels far above estimated breakeven (~119%).
- These prices directly pressure premiums and employer budgets; independent public sources in NYC highlight persistent price variation and affordability risks.
- Action for employers: require rate moderation, allow tiering/steerage to reasonable alternatives, and leverage price transparency datasets (CMS HPT/TiC, RAND) to set renewal targets.
- Their prices are significantly higher than comparable hospitals and providers in the region.
- Proposed rate increases would result in higher premiums and out‑of‑pocket costs for members and employers.
- They have insisted on contract terms that limit competition, including provisions that would restrict our ability to guide members toward lower‑cost, high‑quality providers or design benefit plans that improve affordability.
Northwell Contract Negotiations
Accepting these conditions would increase costs for our members and reduce our ability to maintain a competitive, high‑value provider network.
We remain open to further discussion and hope to reach an agreement that protects both your access and your healthcare costs.
*The commercial “breakeven rate” is the reimbursement rate a hospital needs to receive from commercial payers to cover all of its expenses for hospital inpatient and outpatient services, without pro it. The National Academy of State Health Policy (NASHP) reports commercial breakeven and prices both as multiples of Medicare rates for comparability. (NASHP (2022). Understanding NASHP’s Hospital Cost Tool: Commercial Breakeven. https://nashp.org/commercial-breakeven/).