Individuals and Small Businesses
New York’s managed care health plans provide comprehensive health care services to nearly eleven million adults, children and seniors. These New Yorkers include those enrolled through their employers and individuals who shop for coverage through the state’s official Marketplace or directly from plans. The following member* stories offer real examples about how plans support the health care needs of their members.
* Some names have been changed to protect member privacy
Michael
“Can you feel lucky that you had a heart attack? I don’t know,” wondered Michael O. It may seem strange to say, but for the 57-year-old artist, college professor, the life-changing experience has not only amplified his artistic creativity, but also taught him more than a little about the importance of self-care and healthy habits.
Within days of his heart attack, clinical staff from CDPHP’s Hospital to Home team connected Michael with Movn, a unique virtual cardiac rehabilitation program developed by a California-based company and first introduced in the Capital Region by CDPHP in early 2021. While the number of patients completing cardiac rehab in a traditional setting has historically been low, Movn has impressive results, with over 80 percent of participants completing the program, 85 percent doing better controlling their blood pressure, and 95 percent adhering to their medications. CDPHP’s medical director says Movn is “a game-changer” when it comes to improving access to cardiac care for members.
For Michael, the convenience of the virtual program is most of what has kept him engaged in his rehab and helped him prioritize self-care overall. Now, a year after his heart attack, Michael feels stronger, has more energy, is eating better, and getting more sleep. And his creativity has grown as well. “A lot of my work has been about preserving objects, material culture, things that I find in archives to use in my art,” he explains. “So now, I guess, I’m in this new place of wanting to preserve myself.”
Diane
Diane is a successful small business owner living in the Capital Region. Fluent in five languages, she started an interpreting and translation business during the height of the COVID-19 crisis and today works with local schools, hospitals, health care organizations, and government agencies to provide critical language services to individuals and families in need.
The road to success wasn’t always easy. Diane was an asylum seeker who fled the Republic of Congo in 2015. Pregnant and with a two-year-old son in tow, she landed in Albany, where she and her family were homeless before being connected with Family Promise of the Capital Region, a community-based organization that helps homeless and low-income families achieve sustainable independence. Family Promise, which receives funding from CDPHP, provided Diane and her family a safe place to live, helped her get a job, connected her with immigration lawyers, and accompanied them to doctors appointments. Today, Diane is now an American citizen. In addition to her translation and interpretation business, Diane also volunteers her time helping people like herself, which is her way to pay it forward in a way that’s both personal to her and impactful to her community.
David
A few years ago, David was at a low point and, after finding himself relying on substances and increasingly hopeless, he knew he could no longer do it alone and checked into a crisis center. Following a hospitalization in the crisis unit, David received a call from his insurer, CDPHP, that would change his life.
The CDPHP care manager recommended that David connect with aptihealth, a CDPHP partner, that provides comprehensive mental health and substance use therapy, all from a smartphone, computer, or tablet. Through aptihealth, David received the personalized care and support that helped him make positive changes in his life. David says, “aptihealth, from the very beginning, treated me like I was a regular human being. I wasn’t told what to do. I was simply enlightened on what I could do.”
David has been in recovery for two years and today has stable housing, full-time employment, and positive relationships with family and friends.
Nicole
When Nicole was expecting her first baby, it was the middle of the COVID pandemic and she knew she wanted some extra guidance, so she hired a doula. Based on her experience, when she learned she was pregnant again, Nicole knew she and her family were going to work with a doula again.
Recognizing the benefits doulas can provide, from helping with prenatal care, the delivery of the baby and postpartum care, CDPHP provides coverage for doulas.
Dr. Elizabeth Warner, CDPHP’s chief medical officer, notes, “We know from research that women who see doulas have lower rates of cesarean births. They have lower rates of pre-term births, lower rates of depression after delivery. They have higher rates of breastfeeding.”
Nicole says, “It was important to me to have this person on my team that wasn’t part of the medical group — someone who would be there for us.”
Hannah
As Hannah S. finished doing the dishes, she pulled apart dishwasher pods that were stuck together, which burst and splattered. At first, she thought nothing of it, but after a few minutes, suddenly her vision went white and it became extremely painful. She called for an ambulance but the ambulance provider turned her away because it was “not an emergency.”
She knew that as an MVP member, she had access to virtual care services through Gia, a mobile app. Hannah hadn’t used Gia before, but a nurse herself, she knew moments mattered. Just minutes after starting a visit in the app, she received a call from a Gia provider who quickly assessed Hannah’s symptoms and told her she needed to get to the ER and that she would call ahead to Albany Medical Center to let them know Hannah was on her way. The resident physician who met her at the hospital said he had just talked to the Gia provider, and knew Hannah needed to be taken care of right away. After several rounds of eye flushing and being seen by the hospital ophthalmologist, Hannah was stabilized and released with a follow-up appointment. Hannah credits Gia and the quick action of her Gia provider with saving her eyesight.
Julie
Julie M. woke up in the middle of the night and found it difficult to breathe. She couldn’t take in air, and for the otherwise healthy 58-year-old, nothing like this had ever happened before. She was advised to go an emergency department, or a designated cardiac urgent care center like, Enhanced Cardiac Access at 1785 in Clifton Park.
A small wave of comfort washed over Julie to hear the numbers 1785. Julie, who worked in the field of mental and behavioral health care, was called upon in 2019 to serve on her health plan’s Member Advisory Committee to help design of the 1785 building—a joint venture between CDPHP and several local independent specialty medical practices.
Upon arriving, Julie says she was greeted by compassionate and caring staff and had no wait time before being seen. Julie is grateful for the quick, compassionate care she received. “I was able to get results right away and hear the comforting news that it wasn’t serious.”
Simon
Simon W.* is member of United Healthcare. During a vacation in Mexico, Simon’s wife fell very ill and had to be transported to Florida. As her condition worsened, Simon worked with the hospital care coordinator to get his wife back to New York, and was told that transportation by medevac was approved.
He later found out that the care coordinator had made a mistake and the authorization was not approved, forcing him to cancel the medevac reservation. Wanting to get his wife back home so she could receive the care she needed at their local hospital, Simon turned to United Healthcare’s call center and was connected with a Health Advocate. The Health Advocate took immediate action to find a resolution, demonstrating empathy and care throughout the process. Keeping Simon informed every step of the way, the Health Advocate worked with the case manager to expedite the case and get the transportation approved, allowing him to safely get his wife home to receive much needed care.
Krista
Like most people who hear the words, “you’ve got cancer,” Krista G’s immediate thoughts were about treatment — surgery, chemotherapy, radiation, tests, and more. But that’s really just the beginning.
That’s why newly diagnosed Cigna members like Krista are referred to the plan’s Cancer Support Program that offers patients education on what to expect and setting up treatment plans and “sick day” plans, and addresses any gaps in care. When Krista began experiencing anxiety, the cancer program’s whole person care model that provides screenings for stress and depression spotted it quickly and helped connect her to emotional support services. Knowing there was a team to help coordinate providers and assist with her medical and other needs enables Krista to focus on her treatment and recovery.
Jeremy
Even though he had health insurance, when Jeremy D. learned he needed a liver transplant, he and his daughter told his plan, Cigna, they were worried about costs and the strain it might put on Jeremey’s finances.
The Cigna transplant case management team provided information to apply for grant and financial assistance through the American Liver Foundation. They also worked with the drug manufacturer to get a discount on a drug he’d need, reducing the cost by $1,000, which ensured that Jeremy stays in compliance with his medication. The team continued to monitor Jeremy after he was discharged to make sure he was following all appropriate therapies and to provide recovery support services including diabetes management and dietician recommendations.
Ron
After turning 50, Ron W. decided he wanted to lose weight and improve his health. He started some exercise, but needed help making lifestyle changes. Ron had participated in Highmark’s work-site wellness program at his job and was introduced to Highmark’s personalized care management program.
Working with his care manager, he set a modest short-term goal to get his weight down to 200 pounds (from 206 pounds) and a long-term goal of 190 pounds. The care manager suggested purchasing a scale, weighing in twice a week, and monitoring his progress — simple changes. Through education under the care management program, he started making better breakfasts and cooking at home more often, preparing meals ahead of time for the week. Together, Ron and his care manager came up with heathier snack options for work. He also limited his alcohol consumption to 1–2 drinks on occasion and started exercising regularly. After two years of care management, Ron lost 22 pounds — surpassing his long-term goal — and set a new goal to break 180 pounds. Thanks to Ron’s lifestyle changes, he also saw improvements in his work performance, sleep, and stress management — outcomes that have all contributed to a more positive sense of well-being.
