Excellus BlueCross BlueShield recently announced the recipients of its 2022 Health Equity awards, which represent more than $560,000 in financial support for community programs that address racial and ethnic health disparities across its upstate New York service area.
Earlier this year, Excellus BCBS invited organizations to apply for awards of up to $30,000 each to help fund programs to improve health equity in communities of color, especially within Black and Latino communities. These segments continue to suffer from health care and social disadvantages due to racism and discrimination, the agency noted.
Award categories included improving the community’s physical health and mental health, reducing social disparities in health care and ensuring access to health care services.
Excellus BCBS Health Equity Award funding will support seven initiatives in the Rochester region. They are:
Agape Haven of Abundance: Youth Empowerment is a free community- based education program providing urban youth an opportunity to learn skills that support healthy development and aim to reduce at-risk behaviors;
Boys & Girls Club of Geneva, Inc.: The First Thousand Days program was developed to support families with newborns, meeting an important community need;
David’s Refuge:Provides mental health counseling services to improve health equity and increase support for full-time, unpaid family caregivers;
EnCompass Resources for Learning: Created an alliance for Rochester youth from the EnCompass Future Ready program in collaboration with the University of Rochester Medical Center Department of Surgery, city of Rochester and Black Men Achieve. The project will engage youth as co-creators of solutions through 100 hours of educational, mentoring, data collection and outreach programming to contribute to public health addressing community violence;
Ibero-American Action League Inc.:Centro de Oro (Golden Center) serves as an educational center and a gathering place for seniors to meet their social and cultural needs. The focus of the program is to address social isolation and improve well-being by offering both therapeutic services and health assessments to link seniors with the resources and services they need;
Nativity Preparatory Academy of Rochester: The extended day program seeks to enhance Nativity Prep’s tuition-free academic programming by providing students who lack resources with after-school, weekend and summer programs in a safe, nurturing and productive environment, and
Pivital Public Health Partnership: Mental Health Matters is a community education program designed to reduce health disparities by making mental health awareness and support a priority throughout rural Finger Lakes communities.
“This second round of Health Equity Award funding will support underserved people with health disadvantages due to race, ethnicity, disability, sex, gender and/or rural disparities,” says Gina Cuyler, MD, Excellus BCBS vice president of health equity and community investments. “We are proud to align our resources and efforts to partner and identify areas of collaboration with our local community organizations.”
Say you bang your toe badly enough that you need to see a doctor.
Before anyone looks at the bruise, you are asked to answer a bunch of questions about how you feel in general, your living arrangements and other aspects of your life.
“A lot of patients will question, ‘Why am I getting asked about my mood when I’m here for a toenail injury?’” said Dr. Michael Hasselberg, Chief Digital Health Officer at the University of Rochester Medical Center.
A week, a month, a year from now, you may have a more serious injury or illness. Information that once seemed irrelevant suddenly will matter.
“The reason we’re asking you questions … that don’t always seem completely pertinent to why you’re seeing your doctor today is because it will help us help your doctors keep you healthier and could even save your life,” said Dr. Gregg Nicandri, Chief Medical Information Officer and professor of Orthopedic Surgery at URMC.
Using information collected from individuals and populations in order to gauge when a patient may be at risk for an acute illness or worsening of a chronic condition is not a new idea.
Predictive analytics may date back to when Hippocrates had his fourth patient and compared the ailments in that person to those he had seen in his previous three; but tracking trends just by taking notes is cumbersome and inefficient.
Modern predictive analytics uses machine learning – artificial intelligence – to synthesize massive amounts of data into information that guides health care professionals in diagnosing, treating and managing illness.
Medical personnel use predictive analytics to support clinical decision-making by getting “the right information to the right provider in the right context at the right time, in the right format,” said Dr. Balazs Zsenits, Chief Medical Information Officer at Rochester Regional Health.
The algorithms produce results that are akin to “tapping the clinician on the shoulder and saying, “Hey, there’s a better way to look at this,’” said Dr. David Krusch, vice president, IT Applications at RRH.
In an outpatient setting, predictive analytics make sure patients are up-to-date on screenings and vaccinations based on age and risk, and to guide counseling on disease management.
Predictive analytics also help specializations such as radiology, dermatology and ophthalmology, all of which use images in the clinical setting. Predictive analytics among inpatients can help the care team assess an individual’s risks during and after procedures.
URMC built a machine-learning model based on the global characteristics of people who were likely to go to a nursing home for rehabilitation.
“What we found was the biggest kind of predictor of patients going into a nursing home after surgery was their level of social support,” Hasselberg said. “Did they have family connected to them; did they have visiting nurse services set up?”
How a patient answered questions about social, emotional and physical health at previous appointments help doctors assess your risk for a poor post-surgical outcome.
Hasselberg said the information helps surgeons make better decisions about who is ready for surgery and who needs to be delayed so social supports can be put in place.
Predictive models can also synthesize data from monitors to flag patients at risk for sepsis eight hours before clinicians can spot potential problems. “That actually converts into lives saved,” Nicandri said.
Hospitals face penalties if the same patient has to be admitted again in that time for any reason, so they use algorithms to predict who is at risk for hospital readmission within 30 days of discharge.
To show how the model can be proactive, RRH’s Krusch gave an example of a person who has congestive heart failure, a cause of frequent hospitalization.
“That’s because their condition hasn’t been optimized,” he said. “If we can say, ‘You have an issue with fluid retention, we’re going to start your care management on the day of admission and we’re going to put into place a plan where maybe we can send someone out to your home and give you a diuretic to help reduce fluid retention,’ that patient is not only not going to be readmitted, but that patient is going to have a better outcome.”
The model has helped RRH identify patients most at risk and allowed care teams to focus resources on those individuals.
“These allow us to be preventive rather than fixative,” he said.
But algorithms go only so far. If the computer becomes the one that dictates care, doctors are just robots.
“I’ve always said, ‘I wonder when the day is when people pull up to a drive-thru and a computer,’ and you enter your name and … you just select what the recommendations are,” Dr. Jason Feinberg said. “You’re due for a colonoscopy: ‘accept’ or ‘decline.’Ind You press the button and they schedule you or don’t schedule you. But everything really needs to be synthesized and discussed.”
Feinberg said medicine is still an art, and the data can drive “artful discussions.” He says, “The data that gets run through formulas that are predictive are only as good as the discussion at the bedside or in the doctor’s office.”
He gives an analogy of analytics as red, yellow or green lights to counsel patients in making lifestyle changes to manage illness.
“You don’t run through red lights on (Routes) 5 and 20,” he said. “You probably get through some of them, but it’s a high risk.” Using the analytics helps doctors and patients turn red lights to green, “to prove those predictive models wrong. That’s where the art is,” he said.
The personalized approach also is used by insurers to understand the needs of subscribers and their likelihoods of developing certain conditions.
At Excellus BlueCross BlueShield, the insurer analyzes claims data so it can send healthcare information to a subscriber who is newly diagnosed; have a clinical professional contact a subscriber at risk for a chronic condition; support subscribers who have severe illnesses and promote wellness through reminders about preventive care, according to Joy Auch, director of communications.
URMC’s Hasselberg and Nicandri compare how the health data sets create profiles of patients to the way Amazon uses its own algorithms to predict what you want to buy before you know you want it. The model is based on people who share some of your characteristics, but it also relies on your own traits.
But not everyone likes seeing ads pop up for products they have never bought. At the same time, many people willingly allow their cell phones to track their every move. Consumers may be willing to trade privacy for convenience when it comes to calling an Uber, but will they feel the same with their health information?
“Obviously, with medicine, you have to be very careful,” Nicandri said. “Patient privacy and trust have to be absolutely paramount in terms of protecting the data and protecting and establishing that trusted relationship.”
“It will be interesting over the next decade (to see) how this evolves and what society will tolerate,” particularly as big data companies get more into health care, Hasselberg said. He said medical systems are more likely to lobby the federal government to protect data and ensure it is used to further science.
“Technology is opening up amazing opportunities for improving healthcare. When you think about big data and predictive analytics and machine learning, there are like diseases like Alzheimer’s disease, and we actually may actually have the right data to have a cure for Alzheimer’s disease. We just haven’t had the computing power, the data in one place to find that cure. It may be right in front of our faces, and the computer can help us do that.”
Area nonprofits can now apply for Excellus BlueCross BlueShield’s Health Equity awards, which help fund health and wellness programs that address racial and ethnic health disparities in upstate New York.
The application period is now open and closes at 11:59 p.m. on Thursday, Sept. 15.
Application proposals mustincludeclear, defined goals for reducing health disparities and improving health equity for people that face a higher burden of health inequities and social disadvantages.
Organizations will be required to specify how funding will measurably assist in improving racial and ethnic health equity outcomes.
Proposals that have detailed scope, goals, rationale for support and measures will receive the strongest consideration. Award winners will be announced in mid-November.
Health Equity categories include, but are not limited to:
Reducing health disparities in racial, ethnic, LGBTQ communities, people with disabilities, people living in rural or urban communities or other groups of people that may be at a higher health risk for:
Medical issues and conditions (chronic or acute);
Behavioral health or mental health conditions, or
Negative outcomes from the above, including death or suicide.
“At Excellus BlueCross BlueShield, the health of our communities is at the center of everything we do,” said Gina Cuyler, MD, vice president of Health Equity and Community Investments, Excellus BCBS, in a statement. “Together we can confront the crisis in health disparities, embrace and address long-standing gaps in care and bridge health equity gaps in our underserved communities.”
Excellus BlueCross BlueShield is working to help the community become vaccine ready during National Minority Health Month.
Excellus BCBS has created a dedicated COVID-19 website that offers up-to-the-minute information on what individuals need to know such as how to schedule an appointment, “Ask the Expert” videos, what to expect after you get the vaccine, benefits and coverage and more.
The health plan has also:
• created COVID-19 educational materials and resources that are available in Spanish and English;
• is calling customers to remind them of their second vaccine dose appointment; and
• is offering community-based educational roadshows to educate the public on why getting the COVID-19 vaccine is imperative.
This year’s National Minority Health Month is focusing on the need for vulnerable communities to get vaccine ready as more vaccines become available, and is using the hashtag #VaccineReady to bring attention to the issue.
“We’re specifically encouraging our Black and Brown communities who are eligible to get the facts and to register for a COVID-19 appointment as soon as they can to help reduce the spread of the virus,” said Lisa Harris, vice president of medical affairs with Excellus BCBS.
The organization is advising everyone to get the facts about COVID-19 vaccines, share accurate vaccine information with others, get vaccinated when you have the opportunity and practice COVID-19 safety measures.
“The main thing to remember is that all three of the COVID-19 vaccines are among the most effective vaccines in history. The best choice for you is whichever vaccine you have access to first,” Harris said. “We ask that you share this information with friends, loved ones and neighbors so everyone has the facts about the COVID-19 vaccines and understands the importance of getting vaccinated.”
National Minority Health Month is presented each April by the U.S. Department of Health and Human Services Office of Minority Health.
Rochester’s Excellus BlueCross BlueShield on Friday reported a 43 percent decline in net income for 2020. The health plan also reported its top three executives’ salaries, which totaled nearly $6 million last year.
In fiscal 2020, the health plan reported $6.2 billion in premium revenue, with net income of $97.2 million, a $73.6 million decline from $170.8 million in 2019. The full-year results amount to a net income of $68.40 per member for the entire year, down from $113.87 per member in 2019.
“No one has ever faced a year like 2020,” Booth said in a statement. “The COVID-19 crisis required a strong and comprehensive response to assure our members were able to receive the care they needed and to help assure the health care system itself would survive. The pandemic devastated the economy and sickened tens of thousands of upstate residents.”
Booth noted that the organization took concrete steps to help members, provider partners, employer groups and brokers cope with the challenges created by COVID-19.
“We also reached out to local community organizations with financial support and resources to help them address real community needs,” he added.
During 2020, Excellus BCBS addressed the community needs resulting from the COVID-19 pandemic through financial support including:
• $102 million to pay for increased telemedicine coverage and increased provider reimbursement rates;
• More than $40 million in cash advances to providers approved beyond the normal $192 million in advances;
• $1 million in grants to hospitals for COVID-19 testing supplies and personal protective equipment;
• $250,000 in grants to hospitals for COVID-19 testing machines;
• $1.5 million in grants and sponsorships for locally-based health-related initiatives;
• $51 million to cover the cost of suspending prior authorization reviews, clinical editing programs and claim filing requirements;
• $3 million to cover the mandated increase in reimbursement for COVID-19 hospital admissions;
• $600,000 in grants to community-based food banks and pantries;
• $50,000 to support local domestic violence prevention organizations;
• $30,000 in grants to local diaper banks;
• $17.6 million in medical premium refund credits to large employers;
• $3.4 million in dental premium refund credits to employers; and
• $200,000 in grants for “return-to-work” kits for employers.
Total membership in the health plan grew by more than 13,000 during 2020, the fourth consecutive year membership has grown. Excellus BCBS has a total membership of 1.5 million. More than 95 percent of the Upstate New York population has some form of health coverage by private insurance or government-sponsored programs according to the latest reported figures from the U.S. Census Bureau.
Last year, Excellus BCBS’ rate increase request for 2021 in the individual market was 87 percent lower than the state average of all insurers and its rate increase request for small groups was 61 percent lower than the state average, the nonprofit organization noted.
“For the past four years, the health plan’s rate adjustments in the individual and group markets were far below the state average requests by other health plans,” Booth said.
Last year, Booth earned $3.26 million, while Chief Administrative Officer and General Counsel Stephen Sloan earned $1.41 million. The health plan’s Chief Financial Officer Christopher Gorecki’s salary was $1.1 million in 2020, according to the report. Booth is slated to retire on May 1. He will be succeeded by James Reed, regional president in the Central New York market.
Excellus BCBS paid $530.5 million in federal and state taxes in 2020, including $112 million for the federal tax to pay for the Affordable Care Act. The company’s reserves were $1.2 billion at the end of 2020, or the equivalent of 70 days of claims and expenses.
“The health plan spent more than $5 billion, or an average of $14.2 million every day, covering the health care cost for our 1.5 million members,” Gorecki said.
The federal government’s latest quality ratings have awarded the Medicare Advantage programs from Excellus BCBS with some of the highest ratings in the state, officials said. Medicare awarded the organization with 4.5 stars out of a possible 5-star rating for its Medicare Blue Choice HMO plans and its Medicare PPO plans. For the fifth year in a row, the Medicare Part D prescription drug plan from Excellus BCBS received a 5-star rating, the highest rating possible.
“This continues to be a well-run health plan and the company’s performance reflects that,” said Marianne Gaige, chairwoman of the health plan’s board of directors. “As a taxpaying nonprofit, our business helped our communities through the pandemic and assured members of access to coverage. We continued to offer competitively priced health plans and those products were recognized for their high quality. We also achieved a financially responsible margin to assure the company continues as a major partner for health care providers and a major employer in upstate New York.”
Excellus BlueCross BlueShield will introduce two new health insurance plans and two new dental insurance plans for 2021 to help people who may be retired but too young for Medicare or who may have lost their coverage due to employment changes.
The health insurance plans, Destination 65 Silver and Destination 65 Gold, are designed to help members bridge the gap to Medicare coverage, for which most people become eligible at age 65.
“We are trying to meet the needs of our community members where they are in their lives,” said Todd Muscatello, senior vice-president of segment strategy and performance for Excellus BCBS. “Many people end up retiring before age 65 for whatever reason and then have to find coverage for themselves. Or they may have a spouse that is still working or may already be on Medicare.”
Both options offer no-cost preventive care, coverage for doctor visits and specialty care, urgent care visits, hospitalizations and prescription drugs. The plans have a deductible with an out of pocket maximum. The plans qualify for a health savings account, which allows members to pay for medical expenses with pretax dollars.
Excellus BlueCross BlueShield also is introducing two new dental coverage plans called Blue Select Family Dental and Blue Select Premier Dental. Both plans offer comprehensive coverage for cleanings and exams, routine X-rays and filings, and they meet the mandated pediatric dental essential health benefits included in the Affordable Care Act.
“We know more than one in four adults have untreated tooth decay and almost half of all adults over age 30 show signs of gum disease,” Muscatello said. “That can have serious health implications for people down the road. Up to 120 medical conditions can be detected early through examination of the mouth, throat and neck.”
The new dental plans feature a cleaning and preventive adult oral exam every six months at no cost to members. Other services may fall under the $50 annual single deductible or $150 deductible for more than one person on the policy.
Excellus BlueCross BlueShield has teamed with Foodlink Inc. on a Fresh Account at Curbside Market program.
As part of the pilot project, Excellus BCBS members with the greatest risk of food insecurity and health care needs will receive a monthly $30 voucher for six months to redeem at Foodlink’s participating locations.
The Curbside Market is Foodlink’s mobile farmer’s market, which provides affordable and convenient access to healthy foods in underserved communities.
A new analysis conducted for Excellus BCBS by data science company Algorex Health Technologies identified food insecurity as one of the most prominent needs in Rochester. A separate study by Feeding America shows food insecurity in Foodlink’s 10-county region is expected to rise 45 percent this year due to the pandemic.
“Understanding how social determinants impact our members’ health allows us to provide them with better care,” said Excellus BCBS Vice President and Chief Medical Officer for Safety Net and Population Management Brian Steele. “Food insecurity, apart from the pandemic. was identified as a clear need in our community. You need a healthy diet to improve and maintain good health. This seemed to be an area where we could intervene.”
Program participants are connected with nurse care managers who support the members’ health care needs. The care managers help identify gaps in care, encourage the continuation of medical care and identify available community resources. Improving overall health helps reduce emergency department and hospital admissions, officials noted.
“This is an exciting partnership for Foodlink and Curbside Market because it aligns perfectly with our mission as a public health organization,” said Foodlink President and CEO Julia Tedesco. “The Fresh Account program helps people access healthier foods and celebrates making the healthy choice the easy choice. We hope this will improve Excellus BCBS member experience and health outcomes — and lower health care costs.”
The pilot launched Aug. 1 with 250 members and an additional 250 members are expected to be enrolled this year.
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.