WORKING TOGETHER for Healthier Communities
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Local people WORKING TOGETHER for healthier communities. 2013 Annual Report of Caring Making a significant footprint in upstate New York How much of a mark does The Lifetime Healthcare Companies make on where we live and work? Considering that we serve 1.8 million members, employ almost 6,000 people and are one of the area’s largest consumers of local goods and services, our company has a pretty big footprint. We’re talking billions of dollars that The Lifetime Healthcare Companies pours into the local economy each year. Here are some facts and figures from our annual economic report, “Contributing to a Healthy Economy for Upstate New York.” In 2012, we Disbursed $5.2 billion Paid employees Spent $325 million Added $203 million Paid more than to more than 130 hospitals, $386 million on local goods to the upstate New York $1.5 billion 18,000 providers and services economy through indirect in taxes and and 61,000 pharmacies and induced spending, assessments. generating an additional 1,755 jobs Health care is LOCAL. That’s the way it should be. Chris Booth, CEO of The Lifetime Healthcare Companies Photo by K. McKinzie, Rochester Business Journal All politics is local. Health care is local, too. That’s the way it should be. You want your medical care from doctors and hospitals near where you work and live. That’s why it’s important that your health insurer is local, too. As a health plan and provider of health care services, we have a vested interest in the well-being of our members, patients, providers and communities. Our mission statement says it all: provide affordable access to quality care. We collaborate with others in our communities to improve the health and quality of life of adults and children, and we partner with hospitals, doctors and other health care professionals to deliver care effectively and efficiently. Mark Cohen, one of our Lifetime Health Medical Group physicians, says when you focus on quality, everything else follows. I agree. The proof is in the results. National accrediting organizations consistently rate our services high. Health care costs in our communities are significantly lower than national averages. Upstate New York’s uninsured rate is also substantially below national averages. In fact, the uninsured rate is already below the long-term targets for federal health care reform. We’ve spent the last three years implementing Affordable Care Act provisions and preparing for the health care exchange. Our employees worked long and hard to get us ready for the New York State of Health marketplace. Although I’ve been CEO of The Lifetime Healthcare Companies for just over a year, I’m confident that this company is headed in the right direction. I’m excited about our future and our contributions to upstate New York. We have a great senior leadership team and talented, hardworking employees. We have a long-term plan that will guide us through changes in the health care industry. Our hearts are in the right place: to stay a nonprofit organization and bring value to our members and communities. The big picture of our success is the reflection of innumerable individual customer experiences. Whether we’ve helped a member, a patient, a provider or a member of our community, we believe we have meaningfully affected people’s lives for the better. In this publication, we share stories about the people and organizations we’re honored to serve and support. I’m proud to be part of a company that truly cares about this place we call home. 1 EXCELLUS BLUECROSS BLUESHIELD, CENTRAL NEW YORK REGION Based in Syracuse with an additional office in Watertown EXCELLUS BLUECROSS BLUESHIELD, ROCHESTER REGION EXCELLUS BLUECROSS BLUESHIELD, Based in Rochester UTICA REGION Based in Utica with offices in Plattsburgh and Oneonta UNIVERA HEALTHCARE Based in Buffalo with an additional office in Lakewood EXCELLUS BLUECROSS BLUESHIELD, SOUTHERN TIER REGION Based in Elmira with an additional office in Binghamton EXCELLUS BLUECROSS BLUESHIELD &UNIVERA HEALTHCARE Collectively, our health insurance companies and subsidiaries fall under the name of The Lifetime Healthcare Companies. We operate as one company, but the vast majority of our business is as upstate New York’s largest nonprofit health insurer. As Excellus BlueCross BlueShield, we serve members in 31 counties in four main regions: Central New York, Central New York Southern Tier, Rochester and Utica. In eight western New York counties, we operate as Univera Healthcare. We have many programs and services dedicated to our members’ care—from medical and pharmacy management to Medicare Advantage plans and safety net programs for underserved populations. We also collaborate with hospitals, doctors and other professional health care providers to ensure that the care they provide is safe, effective and efficient. We believe that it takes many people and organizations to build better communities and so we partner with and support other local nonprofit agencies that believe improving where we work and live is the right thing to do. The value of our community-based, nonprofit health plan • Lower margins that help produce lower premiums. • Strong commitment to safety net programs. • Safe, but modest reserves. • High-quality coverage and service. • More of the premium spent on medical benefits. • Local partnerships that improve care. • Higher rate of employment-based coverage. • Positive economic impact. • Lower uninsured rate. 2 Taking care of CUSTOMERS one member at a time 3 Jacinta and her daughter, Sarai. 4 Jacinta counts CHILD HEALTH PLUS a blessing When Sarai was an infant, she had constant ear infections. Her mother, Jacinta, recalls taking her daughter to the pediatrician’s office sometimes twice a week. With her insurance copays costing $20 a visit, the fees started to add up quickly. But what could she do? This was her daughter’s health. Enter Child Health Plus, the New York state sponsored plan that provides free or low-cost health insurance for children ages newborn to 19 who live in-state. Because there are no office visit copays and there is a lower premium, Jacinta knew that enrolling Sarai in Child Health Plus was a no-brainer. “Child Health Plus alleviates a financial burden,” says Jacinta. When Sarai was 13 months old, Jacinta enrolled her daughter in Child Health Plus. Jacinta is grateful for the coverage it provides, including outpatient surgery to have tubes inserted in Sarai’s ears when she was 18 months old. Now that Sarai is 5, she has outgrown her ear infections, but still needs sick and well-child visits with her pediatrician. Child Health Plus also covers prescriptions, hospitalizations, regular medical services, checkups, immunization shots, vision care, dental care, mental health care, X-rays and basic laboratory tests. The plan also covers hospital emergency room treatment if it involves an actual medical emergency or accidental injury. “No child should have to go without health care in New York,” said Sheila Betters, Safety Net and Government Programs Sales and Marketing Director. Family size and income determine monthly premium costs. Excellus BCBS and Univera Community Health, along with other insurers, administer Child Health Plus and other safety net programs With the money she saves with Child Health Plus, Jacinta can better afford for Sarai to attend The Harley School. The independent college preparatory school has a flexible tuition program, allowing parents to pay what they can afford and providing financial aid for those like Jacinta who need assistance. “I may be biased, but I think Sarai is academically a whiz,” said Jacinta. “She loves school, math, science and writing, anything that involves learning.” “Last weekend, we rode our bikes so she could collect things around the neighborhood to make a science project.” Jacinta described her daughter as a “girly girl” who is soft spoken but doesn’t bite her tongue, keeping her mom on her toes. “She is the love of my life, my everything,” said Jacinta. “I’m glad I have Child Health Plus to keep her healthy.” 5 CUSTOMER SERVICE comes through for Darleen Nervous. Darleen Snyder of East Syracuse was like many members who call Customer Service. Unsure of what to expect, they sometimes anticipate the worst. Although Excellus BCBS had been paying claims for the medical equipment Darleen needed to treat an old injury, earlier this year the medical equipment company began billing her. When she contacted Customer Service to ask why her claims were denied, Customer Service Advocate Danielle (Dee) Caryl answered her call. “When Dee took the call the first two times, then offered to speak to the billing company to reduce the stress for me, what a relief!” Darleen recalled. After investigating Darleen’s claims, Dee learned that the Excellus BCBS member mistakenly had applied to another insurer that covers work-related injuries. Turns out the coverage wasn’t applicable. However, she had to complete the paperwork in order for that insurer to deny her application and for Excellus BCBS to pay her claims. On top of everything, Darleen was going through a difficult personal time because a family member was seriously ill. Dee walked Darlene step by step through the necessary paperwork. It took a few months and many phone calls to resolve the issue. Darleen would only talk with Dee. “I didn’t want to have to go through the whole scenario with someone who was new to my case,” Darleen explained. She appreciated that she wasn’t passed from one person to another. If Dee wasn’t available, Darleen would leave a message. Dee called her back at the first opportunity. “Dee gave me directions. She kept me calm. She listened. She’s a very caring, remarkable person. I call her one of my angels,” said Darleen, who agreed to be photographed with Dee for this publication.