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Insurer stations patient care managers at Ellis Hospital

Insurer stations patient care managers at Ellis Hospital

Collaborative effort designed to improve CDPHP member satisfaction
Insurer stations patient care managers at Ellis Hospital
John D. Bennett, CDPHP president and CEO, speaks Tuesday. At right, Ellis Medicine President & CEO John D. Bennett.
Photographer: MARC SCHULTZ/GAZETTE PHOTOGRAPHER

SCHENECTADY — Patient care managers employed by health insurer CDPHP are now embedded at Ellis Hospital, helping patients navigate paperwork and helping plan their care after they leave the hospital.

CDPHP and Ellis Medicine announced the initiative Tuesday. It is, Ellis CEO Paul Milton said, a collaborative effort to “improve the patient experience.”

Dr. John Bennett, CEO of CDPHP, said he’d spent much of his professional life in hospitals giving care but has developed a better appreciation of what it’s like to be a patient.

“If you’ve ever been admitted to a hospital, it’s a scary thing,” Bennett said, explaining that the patient worries foremost about getting well, and about whether everyone at the hospital is communicating effectively to make that happen.

“And then on top of that, from the health plan perspective, there’s some financial concerns you have,” Bennett said. “'Is this covered?' 'Am I going to be seen by an out-of-network doctor?' 'What’s going on?' 'What’s my deductible?' 'What do I have to worry about?'"

“The thing that strikes me is that in our system, as it’s gotten more complex, it’s almost gotten more disconnected," Bennett concluded. "So, we changed our system.”

Dignitaries on Tuesday also cut the ribbon on the new Customer Connect office at Ellis, the fourth systemwide for CDPHP and the first in a hospital. Its staff of five people, all CDPHP employees, began assisting patients June 21.

The focus is on those admitted to the hospital — approximately 40 of the 200 inpatients at Ellis on a given day are CDPHP members — but members who have not been admitted also can get advice. The office is open from 8 a.m. to 8 p.m.

Bennett summarized the duties of the patient care team his company has placed at Ellis:

  • Help patients understand their benefits;
  • Educate patients about programs and services CDPHP and Ellis offer;
  • Resolve questions about medication both in the hospital and at home, as the transition between the two is a fragile time for patients.
  • Aid communication among the hospital team and with the physician who’ll be seeing the patient after discharge;
  • Assess the post-discharge care needs;
  • Help arrange followup appointments; and
  • Help make sure discharge summaries and other information get to physicians.

This is not, Bennett said, an effort by the insurer or hospital to cut costs.

“The only return on investment I want to see is satisfied members and patients at Ellis Hospital,” he said.

Health care providers and health insurance providers sometimes find themselves on opposite sides of the table as they attempt to keep afloat in the U.S. health care system, which is officially estimated to cost $3.5 trillion a year, more than the entire gross domestic product of all but four of the world’s nations.

The repartee at Tuesday’s announcement reflected the ongoing debate over a proposed New York state takeover of health care insurance at an estimated annual taxpayer cost of $140 billion. The single-payer measure stalled in the Legislature this year but is far from dead, and CDPHP has been advocating publicly against it.

“These kind of things require the private sector to deliver partnerships in the community,” Bennett said Tuesday, in not his only praise of the private sector.

State Sen. George Amedore, R-Rotterdam, a staunch smaller-government advocate (and since the November 2018 election, part of the minority in the Senate) also advocated for continued private-sector control of health insurance.

“Health insurance plan benefit coverage is almost as difficult to understand as the tax code,” Amedore said. “I hope that this program spreads all across the state of New York because we need this out-of-the-box thinking in every hospital.”

Assemblyman Phil Steck, D-Colonie, who holds the opposite position on single-payer, said he too likes the CDPHP-Ellis program.

“This is a great example of the outstanding work that the private sector does,” Steck said. “It almost convinces me, Dr. Bennett, to give up my support for single-payer health insurance.”

As Amedore began to applaud, Steck repeated “Almost.”

Schenectady Mayor Gary McCarthy kept his remarks focused locally at Tuesday’s ceremony, framing the partnership as one more way to make the city better.

“When people make a decision on where they’re going to move their businesses, where they want to establish relationships, health care is a major component of that decision,” McCarthy said. The patient care management program, he said, “sets the standards for other communities and it moves Schenectady up another notch.”

Bennett and Milton said Ellis’ status as independent and relatively small in a market dominated by Albany Medical Center and St. Peter’s Health Partners made it easier to negotiate the cooperative venture.

Milton said he’s open to similar collaboration with other insurers. Bennett said he’s trying to create such collaborations with other hospitals.

“We are in discussions with Albany Medical Center and St. Peter’s, and I believe we will be successful in doing that," Bennett said. "But we’re very pleased that Ellis is small, nimble and locally controlled, so we can do these things faster. It definitely is a plus, and it is why we started with Ellis.”

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