For Dr. Nicholas Massa, vice president of medical affairs at Excellus BlueCross BlueShield, collaboration and quality have been cornerstones of his remarkable 25-year medical career. As a dedicated local physician, he began his journey as a graduate, resident, and practitioner of pediatrics at Upstate University Hospital, where he fostered partnerships, developed innovative programs, and prioritized affordability.
“My priority has always been on the patient’s health and well-being, and this commitment has driven me to foster strong partnerships with our community organizations, health plans, doctors, and hospitals,” says Massa.
Today, he uses this focus on high-quality patient care in his current role at Excellus BCBS. At the nonprofit health plan, he collaborates with 24 other physicians and is a leader among the hundreds of clinical staff, including pharmacy, nursing, and social work team members. Together, they establish a framework for doctors and hospitals to work in unison
with the insurance company, developing best practices that impact access to high quality care.
At Excellus BCBS, positive and collaborative relationships are essential to providing quality, accessible and affordable care to its 1.5 million members across 39 counties of upstate New York. Ninety-eight percent of all local doctors and hospitals are in the insurer’s provider network. These doctors provide high-quality health care, and their work helps the insurer fulfill its mission: To help people in our communities live healthier and more secure lives through access to high-quality, affordable health care.
“When I think of our mission I keep coming back to collaboration because it’s key to how we address the rising costs of healthcare while also maintaining the level of care our members need and deserve,” says Massa.
The team at Excellus BCBS has made collaboration a priority for the betterment of their members by:
• Providing education on the benefits of health screenings and vaccinations
• Supporting community organizations and providers who are breaking down barriers in health care related to race, ethnicity, or social determinates of health
• Connecting its members with a range of support to meet their needs, using internal resources and external partnerships.
“That’s why we’re here. That’s one of the strengths of a local, regional, nonprofit health plan,” Massa adds. “Our focus at Excellus BCBS is on our communities, on quality of care, and on providing it to our members in a way that is as affordable as possible.”
Quality of Care
That focus on quality is what recently earned CNY Family Care in Syracuse an honor from Excellus BCBS known as the “Circle of Excellence Innovation Award.”
Four years ago, CNY Family Care implemented a diagnostic tool for diabetic patients called Retina Vue. “We are very progressive with various types of testing and education,” says Dr. Joseph Augustine, a primary care physician at CNY Family Care.
With diabetes cases on the rise, Retina Vue provides a quick, in-office scan of the retina, allowing physicians to advise patients on next steps within minutes. This proactive approach shows how primary care practices like CNY Family Care prioritize the prevention of complications associated with diabetes.
“Trust is crucial between a provider and patient. The most significant aspect for doctors and patients is building a relationship and diligently following up on conversations, especially regarding diagnoses,” Augustine explains.
“This quality care is measured by health plans like Excellus BCBS, who recognize the importance of that relationship and trust,” says Tony Vitagliano, VP, provider network, Excellus BCBS.
The Circle of Excellence award is not a financial incentive award, but rather a peer-nominated award. The award highlights visionary, quality, and health equity thought leaders in the Excellus BCBS provider network who have made significant impacts on health care delivery and the lives of the health plan’s members.
“We developed the Circle of Excellence awards to recognize those who work in partnership with us and look at different ways to deliver accessible and high-quality care,” Vitagliano said. “Because of doctors like those at CNY Family Care, patients are getting the care they need, when they need it. It’s partnerships like these that make us incredibly proud.”
Access to Care
When providers and insurers work together to improve access to care, they can significantly impact their communities.
“Just as coordination and collaboration have better ensured quality care for patients, they have also helped us to address health disparities,” Massa says. “Part of being a good doctor means getting to know your patients; we recognize that our network of providers has strong relationships with the people they care for, and that trust leads to better outcomes and greater access.”
A prime example in Central New York is Cayuga Health Partners (CHP), a proud partner of Excellus BCBS. This clinically integrated network of primary care and specialty physicians, in conjunction with Cayuga Health System, has established a closed-loop referral process. This process integrates social needs screening, connects patients directly to community resources, and provides direct feedback to providers.
“CHP, an Ithaca-based organization, sets the bar high for the work it has done to help underserved populations through healthcare and social services interventions,” Massa says. CHP CEO Rob Lawlis couldn’t agree more. “We are leading the region with our commitment to health equity and developing health equity capabilities,” Lawlis says. “By addressing unmet social needs, CHP is taking steps to address major barriers to health and wellbeing for vulnerable populations in the community.”
One such step is through a program called “We Ask Because We Care,” in which patients are invited to answer optional questions about race, ethnicity, sex at birth and current gender identity.
Dr. John-Paul Mead, medical director at CHP, adds, “With the data, we can see if there’s a problem with a group that isn’t getting tested in the Ithaca area. We can look at that group and ask, what’s the mammogram rate for that subpopulation?’”
After spending three years mining the data among their patient population— with 80% responding—CHP has identified specific groups it can target for preventive diagnostics. That rate of response means the data is valid, so CHP can get to work.
“We Ask Because We Care represents an innovative way to address health inequities,” Vitagliano says. “By leveraging community partnerships like this, we are able to work together to ensure everyone has a chance to live a healthy life.”
Mead is justifiably proud of the program and its partnership with Excellus BCBS. “Excellus BCBS, like CHP, is truly working to help their members—our patients,” Mead says. “Their support allows us to make an impact on patients’ lives. We both understand that it’s not
Affordability of Care
just about saving money, but instead about saving lives and preventing disease.”
While ensuring that members receive the best possible clinical outcomes and access to care, Excellus BCBS is also dedicated to making health care as affordable as possible.
Through programs that work directly with members, their doctors, and the health plan, these collaborations, as Massa explains, allow Excellus BCBS to provide more comprehensive, coordinated, and, at times, even more convenient care for high-risk members while reducing the need for expensive health care services.
REACH Kidney Care
ElenaMarie Burns, an Excellus BCBS employee, faced the challenges of navigating chronic kidney disease (CKD) when her father suffered a stroke in his 50s that led to the discovery that his kidneys were not functioning properly.
She remembers times when her father would stop taking his medication or resist following the doctor’s dietary instructions. “We didn’t have someone to sit and talk to him, like a care management team to have that coordination of care. I think he could have benefited from that,” says Burns. Within a couple of years of diagnosis, her father began dialysis. “The dialysis really did a number on him.”
REACH Kidney Care didn’t exist when Burns was going through this stressful time with her father. Today, this kidney health management program partners with Excellus BCBS and its network nephrologists to provide its members with stage 4-5 chronic kidney disease services that help them to navigate their care and follow their physician’s treatment plan.
Knowing what is available to patients and caregivers now, she says, “I think that education (provided by the Excellus BCBS care management team and REACH Kidney Care) would have given my father a better quality of life.”
Through REACH, members work one-on-one with a multi-disciplinary care team that provides personalized support to help members make the most of their care and manage their CKD. The REACH program is offered virtually, over the phone and in-person at no cost to members that have this benefit included in their plan.
“This program allows us to improve the health of our CKD patients and keep them out of the hospital, decreasing the cost of care,” says Dr. Philip Ondocin of Nephrology Associates of Syracuse. “Excellus BCBS members who are eligible for the program are offered social support and psychological services, which are hard to get for dialysis patients.”
WellBe Senior Medical
WellBe Senior Medical has partnered with Excellus BCBS to bring care directly to the homes of some of the most vulnerable Medicare Advantage members, helping to reduce unnecessary medical costs and improve quality of care.
For 95-year-old member “Ms. D” who was ready for hospice but didn’t qualify based on her diagnoses, WellBe being a part of her care meant she could spend her final days at home with her daughters by her side.
“Ms. D’s WellBe clinical team collaborated closely with her family as an added in-home resource and when her daughters placed an urgent call to WellBe as her mother was having trouble walking and breathing,” says Nurse Practitioner Liz Vasquez, WellBe’s clinical director. “We were able to recognize signs of congestive heart failure and discussed hospital stabilization or hospice enrollment.”
Despite not qualifying for hospice through her existing diagnoses and lack of an echocardiogram, the WellBe team used the Framingham CHF Criteria to diagnose her condition accurately, enabling Ms. D to then qualify for hospice care at home.
“This is just one example of how we focus on patients with serious chronic illnesses, or who are either homebound or home-limited, meaning that it’s difficult for them to get out of the house for appointments,” explains Dr. Raghu Ram, WellBe regional chief medical
officer.
Eligible Excellus BCBS members benefit from personalized in-home care as needed, help managing prescription medications, and in home urgent care services available 24/7.
WellBe collaborates with the patient’s primary care physicians, so they are seen, in the home, between office visits. The goal of this collaboration is to improve outcomes and health care quality, reduce unnecessary medical costs, and provide exceptional member experience.
Additionally, by visiting patients at home, providers can address issues such as personal safety, fall risk, and food insecurity. “We’re often able to see things that may be of concern that wouldn’t otherwise be seen in an office setting,” Ram says.
Excellus BCBS Pharmacy Concierge Program
High drug prices are challenging health plans, employers, patients, and the entire health care system. This upward trend, which is projected to continue in the coming years, has serious consequences for millions of Americans, as one third of the U.S. population reports not taking medication as prescribed because it is just too expensive, according to the American Hospital Association.
The high cost of prescription drugs and the resulting burden on members led Excellus BCBS to develop Pharmacy Concierge, an innovative approach to improving care while reducing costs.
“Pharmacy Concierge makes a powerful difference for our members,” says Massa. “We’re proud that a program now exists that ensures our members are using the most appropriate and cost-effective therapy options.”
The concept of improving care and reducing pharmacy costs by identifying lower-cost generics or modifications to dosages is not unique. “What is unique about Pharmacy Concierge is our focus on health outcomes and safety,” says Excellus BCBS Pharmacist Supervisor Lindsey Shuler.
“It is much more than an algorithm. The program includes a clinical review of every savings intervention and ensures both safety and savings,” she adds.
This past year, the Excellus BCBS clinical team identified a member on an inefficient dosage of a brand name antidepressant. The member was prescribed two tablets daily, despite availability of a higher dose, which would allow for one tablet to be taken daily. The team reached out to the member’s doctor, suggested a change, and today the member is taking the dosage once daily, ensuring a better outcome, as well as saving $3,500 per year.
“We ensure that our recommendation would never result in more out-of-pocket costs for the patient and always ask, ‘What are the most cost effective options that are also the safest for our members?’ We work directly with the prescriber to discuss and suggest alternatives, but the final decision is between the prescriber and patient,” Shuler says.
And with the cost savings often comes medication adherence.
“As a provider, I know that if a patient can afford a medication, they’ll take it more consistently, which provides them a better outcome in the long term,” says Massa.
Collaboration is Key
Excellus BCBS’s strength lies in its commitment to the communities it serves, the doctors and hospitals that it partners with, and the members who rely on them for care.
While costs are increasing in all areas of our lives, from the grocery store to the gas pumps, health care is no exception. But together with its many partners, Excellus BCBS is eager and ready to continue working to prioritize the overall experience and outcomes for their members, providing access to quality care to all people.
“We want our members to have access to the care they need, when they need it, and we do this through strong partnerships, innovative programs to improve affordability, and a relentless focus on our members,” says Massa. “Collaboration is essential in health care because it allows us to leverage strengths and improve where there are weaknesses. By working together, we can create a seamless experience for patients, and ensure they receive the right care at the right time.”
To learn more about these and the many other programs offered through Excellus BCBS, visit excellusbcbs.com.
