Excellus BCBS partners with REACH Kidney Care to improve chronic kidney disease management

“When you think about chronic kidney disease, it affects so many people,” explains Dr. Kathleen Robischon, VP of Medical Affairs and Clinical Services at Excellus BlueCross BlueShield. “Any interventions we can take to slow the progression of the disease are a plus.”

People are diagnosed with chronic kidney disease (CKD) when their kidneys are damaged and unable to perform their normal function of filtering blood. The National Institutes of Health estimates that 1 in 7 adults has a form of CKD. As the disease progresses, kidney function continues to decline.

“When managing chronic kidney disease, we want to reduce risk factors, limit damage to the kidneys and slow progression of the disease,” adds Dr. Robischon. “We provide care management for members with chronic kidney diseases stages 1 through 3. When a member moves into stage 4, we offer the support of REACH Kidney Care.”

How REACH Kidney Care helps

REACH Kidney Care* is a kidney health management program designed to help members with stage 4-5 chronic kidney disease navigate services and follow their physician’s treatment plan. 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. The goal of the program is to improve care while delaying the need for more costly interventions such as dialysis.

“We are pleased that our eligible patients have the opportunity for additional support and resources,” explains Dr. Philip T. Ondocin of Nephrology Associates of Syracuse, PC. “We encourage all patients to maximize their insurance benefits to support their kidney function and slow down the progression of their disease.”

Caring for a loved one with kidney disease

ElenaMarie Burns, Excellus BCBS Provider Programs Project Coordinator, faced the challenges of navigating CKD when her father suffered a stroke in his 50s that led to the discovery that his kidneys were not functioning properly.

As his primary caregiver, her father’s CKD diagnosis marked a significant change in ElenaMarie’s life. “We had to uproot everything because he could not take care of himself,” she explains. This meant giving up her full-time job and moving with her young son to her father’s house to provide the care he needed.

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, that would say ‘hey let’s take a look at all the medications you are taking, hey let’s find out what is going on here’… to have that collaboration of care. I think he could have benefited from that,” says ElenaMarie.

Within a couple of years of diagnosis, her father began dialysis, which eventually meant waking up early and traveling in a medical van to the hospital multiple times each week. “The dialysis really did a number on him,” explains ElenaMarie. “This was a very robust individual and seeing him go down to 140 pounds in the end, he did not look like my dad anymore.”

Support for managing CKD

Dr. Robischon notes that ElenaMarie’s experience is not uncommon as patients and caregivers often face challenges managing multiple medications and doctor’s visits. “There is a lot of information and responsibility that falls on the patient to try to keep track of all of this,” says Dr. Robischon. “REACH works to help support our members and make sure they are getting their labs done and following up with medications and more.”

These care management services were not available when ElenaMarie was caring for her father. Knowing what is available to patients and caregivers now, she says, “I think that education [provided by the care management team and REACH Kidney Care] would have given my father a better quality of life.” And she sees the benefit it would have brought to her as a caregiver. “Having the support and a cheerleading squad pointing me in the right direction would have been so important.”

*REACH Kidney Care is an independent not-for-profit that offers kidney disease management support to Excellus BlueCross BlueShield members.

Member video: Going the extra mile for our members

For Medicare member Frank Pecora, making a call to Customer Care at Excellus BlueCross BlueShield meant finding medications he could afford.

The 75-year-old is one of thousands of members who call the number on the back of their membership card and benefit from the expertise offered by customer care advocates who answer questions on everything from medical claims to prescription refill costs.

Frank, who recently joined Excellus BCBS as a Medicare member, said he was surprised after he refilled two of his prescriptions for the first time and was told he had to pay $192. Frank was unable to afford it after paying $20 on his previous insurance plan.

That’s what prompted him to call Customer Care where he connected with a Customer Care Advocate named Stephanie.

Stephanie talked with Frank and helped him to understand the details of his insurance coverage, including what to expect from the costs associated with his deductible to his prescription plan coverage.

Because Frank was on a high-deductible plan and his Symbicort medication fell under a higher tier level, Stephanie explained to him that he would have to pay his deductible first, which included the $192, and then once that’s reached, he would only have to pay the copay for his medications.

“My number one goal when talking to Frank was to find him alternative, more cost-effective medications,” said Stephanie. “Taking the time to listen, educate our members, and find solutions provides them with a sense of relief. We want them to know we are here to help them access affordable care.”

Stephanie was able to find Frank alternatives to his Symbicort and Albuterol medications at a lower tier level that were comparable to what he was taking and more affordable.

”My doctor agreed that the alternate medications would be fine, and I was able to get new medications that were actually less expensive than what I had been paying out of pocket,” Frank said.

Now instead of paying $192 a month until he met his deductible, Frank only pays $3 a month, which he says is even more affordable than what he was paying before.

“Stephanie made me a happy camper. She took her time with me, answered all my questions, and took care of everything I needed. I couldn’t ask for anything more than that,” says Frank.

Helping our members access care that’s as affordable as possible is critical to our mission at Excellus BCBS. Stephanie says she isn’t surprised Frank was pleased with the outcome of his call.

“Whenever you give someone news about potentially saving money, they are a very happy person, especially for our Medicare members who may be on a fixed income,” Stephanie said. “In Customer Care we do all we can to help all our members get what they need to get and stay healthy at an affordable price.” (Member Video) Hear from Frank about his experience.

(Member Video) Hear from Frank about his experience.

Be safe outdoors – What you need to know about Lyme disease

Summer is a time to work in the garden, visit the dog park, or hit the bike path. It is also a time to be aware of tick-borne illnesses including Lyme disease, and ways to avoid them. Infected ticks can be found across the Northeast, including in upstate New York.

“Lyme disease is a bacterial infection caused by the bite of an infected deer tick,” says Lorna Fitzpatrick, MD, vice president of medical affairs and senior medical director at Excellus BlueCross BlueShield. “Untreated, the disease can cause health problems, including severe headaches, painful arthritis, swelling of the joints, and heart and central nervous system problems.”

Treatment with antibiotics, when the infection is identified early, can result in a quick and complete recovery, according to Fitzpatrick. The big issue, she says, is that Lyme disease often goes undiagnosed, which can lead to chronic symptoms that are hard to resolve.

Preventing tick bites is the best way to protect against tick-borne illnesses. The New York state Department of Health offers these tips:

Know where to expect ticks.

Ticks like shady, moist areas at ground level. They cling to tall grass, brush, and shrubs, usually no more than 18-24 inches off the ground. They also live in lawns and gardens, especially at the edges of woods. When gardening, keep long hair tied back. When hiking, stick to well-cleared paths.

Reduce ticks in your yard.

Keep lawns mowed and edges trimmed. Clear away brush, leaf litter, and tall grass from around the house and at the edges of gardens and stone walls. Stack woodpiles neatly away from the house, and preferably off the ground. Keep the ground under bird feeders clean so as not to attract small animals that can carry ticks into your yard. Locate children’s swing sets and other play equipment in sunny, dry areas of the yard, away from the woods.

While outside, dress to protect.

Wear light-colored clothing with a tight weave to spot ticks easily. Wear enclosed shoes, long pants, and a long-sleeved shirt. Tuck pant legs into socks or boots, and shirts into pants. Check clothes and any exposed skin frequently for ticks.

Consider using repellent.

The NYS Health Dept recommends using EPA-registered insect repellents. For skin, products that have DEET (20% or more) or picaridin (5 to 20% of the active ingredient) can be applied.

For clothes, shoes, and camping gear, treat, or purchase pretreated clothing with permethrin, but never apply permethrin to skin.

After being outside, check yourself and your clothes.

Do a final, full-body tick check at the end of the day (also check children and pets) and remove ticks promptly. If available, put your clothes in a dryer on high heat for 15 minutes to kill any ticks that may be on them.

The New York State Department of Health has more information on Lyme disease, online at Ticks & Lyme Disease – A Guide for Preventing Lyme Disease (ny.gov).

Breaking Down Barriers

Affordable and Accessible Care for All

The ACCEL Clinic, a healthcare facility located at the Economic Opportunity Program in Elmira, NY, is providing affordable care to community members when they need it most.

They couldn’t afford their blood pressure checks

For Glenda and Woody Aikens, residents of West Elmira, the cost of weekly co-pays to have their blood pressure checked was simply not affordable. But thanks to the ACCEL Clinic they have been able to follow their primary care doctor’s orders at no cost. They learned about the clinic through a flyer provided with a food delivery from the Economic Opportunity Program. The Aikens said they were thrilled to discover that the clinic offered free services and easy access, allowing them to consistently monitor their health and interact with others in the community.

The ACCEL Clinic is a collaborative partnership between Excellus BCBS, Arnot Health, Chemung County Health Department, Lake Erie College of Osteopathic Medicine (LECOM), and the Economic Opportunity Program. The clinic provides free and accessible medical services to children and their families.

The ACCEL Clinic is supported by an Excellus BlueCross BlueShield Member and Community Health Improvement grant and the funding has enabled the clinic to enhance health outcomes and reduce health disparities in Chemung County. This has been achieved through the analysis of data collected and has enabled the clinic to provide targeted care and connect them with appropriate healthcare providers.

“The ACCEL Clinic helped us when we needed medical services but couldn’t pay for them,” said Glenda Aikens. “We enjoyed going there every week to check in and we feel important at the clinic. The ACCEL Clinic is great for our community and for people who don’t have much money.”

Surprised by her son’s high lead levels

Other services at the ACCEL Clinic include free lead screenings, an initiative that is in response to the historically high lead levels in Chemung County. The free screenings help the clinic identify and address lead poisoning in children, ensuring early intervention and appropriate treatment.

Tanisha Logan-Lattimore, a patient at the clinic, discovered that her son had high levels of lead through the clinic’s testing.

“I had my entire family tested, including myself. I was surprised when the results showed that my son had very high levels of lead in his body. I had no idea about this before, and it was fortunate that we found out because my son already has a weakened immune system. Sharing the test results with his doctors allowed them to consider the lead exposure when planning his treatment. It was truly a blessing in disguise,” Tanisha stated.

Since its opening in 2022, the clinic has successfully conducted over 400 lead screenings, contributing to the reduction of lead levels in Chemung County, according to Economic Opportunity Program Chief Executive Officer Andrea Ogunwumi.

Access to Affordable Care

Convenience and accessibility are key factors in the success of the ACCEL Clinic. Being in the same building as Head Start programs and after-school activities makes it easier for parents to bring their children in for screenings. This eliminates barriers such as transportation and time constraints, ensuring that healthcare services are readily available to those who need them said Ogunwumi.

The clinic is staffed by LECOM medical students who not only assist with screenings but also ensure that individuals receive necessary primary care follow-up. This includes appointments with primary care physicians and lab screening services provided by Arnot Health. This comprehensive approach to healthcare ensures that individuals receive the necessary care and support to manage their health effectively.

The ACCEL Clinic also collaborates with SNAP-Ed’s Fruit & Vegetable Prescription Program to provide nutritional education services.

“The ACCEL Clinic is a valuable resource in the community, providing cost-free and accessible healthcare services to those in need,” said Dr. Richard R. Terry, LECOM – Elmira Associate Dean of Academic Affair. “A collaborative approach, uniting healthcare organizations, community programs, and funders, is key to improving health outcomes and effectively controlling rising health costs. By working together, these stakeholders can leverage their unique strengths and resources, creating a powerful synergy that fosters innovation, efficiency, and sustainability in healthcare delivery. Through collective efforts, they not only enhance the quality of care but also address the root causes of health disparities, ultimately paving the way for healthier communities and a more cost-effective healthcare system.”

My Lifetime Story: Taking Steps Towards Health Equity

A Healthier Upstate Contributor

As part of Melissa Klinko’s professional development, she was able to enroll in an online Harvard business course, fully sponsored by Excellus BlueCross BlueShield, that specifically focused on addressing and reducing health care disparities. Little did she know that this experience would open her eyes to the underlying causes of these disparities and provide her with real-world examples and case studies.

*Melissa Klinko is a corporate communications manager for Excellus BlueCross BlueShield*

My New Perspective

During the course, Melissa gained a new perspective on healthcare and realized the impact of unconscious biases. It was a moment of self-reflection when she recognized that she had assumed the doctor she was seeing was Asian based solely on her last name. However, upon meeting her, she discovered her assumption was incorrect. This incident made her acutely aware of the unconscious biases we all carry and the importance of addressing them to provide equitable care to all individuals.

Melissa’s awareness of disparities in healthcare was further heightened by her brother’s experience. As an adoptee from Korea, he often faces the expectation that he should be able to speak Korean. This expectation becomes frustrating, especially in certain situations. Language barriers are one of the biggest obstacles in healthcare, leading to a lack of care and confusion regarding medications and next steps in treatment. This realization solidified her belief that health equity is crucial in bridging these disparities.

Recognizing and Educating

By recognizing and addressing systemic racism and biases, we can ensure that everyone receives the care they deserve. It is through educational opportunities like the Harvard Business course, that we can contribute to closing the gaps in healthcare.

Melissa shared that one of the most intriguing aspects of the course was learning about the Kotter method, which helps identify organizational gaps and needs. This method helps to create a vision for change and implement an executable strategy to reduce disparities. Additionally, the course emphasized the importance of collecting and analyzing data unique to underserved populations. By utilizing this data, we can effectively inform and drive meaningful change.

“I am grateful to work for a company that values health equity and actively supports its employees in recognizing disparities in healthcare and education. By providing resources and fostering awareness, our company ensures that we are aware of how situations are perceived and how we can contribute to making a positive difference.”

We Care About Health Equity

Melissa’s experience sheds light on how Excellus BCBS goes above and beyond in fostering a culture of continuous learning and support for their employees.

Are you interested in joining the Excellus BCBS team?

We have the right fit for you. Positions are available in many departments including Customer Care, Operational Excellence, Marketing and Sales, Information Technology, and more. Check us out at careers.excellusbcbs.com. Get to know our people and our values, and grow your relationship with us. For more information, reach out to Director of Talent Acquisition Jason Helsdon at Jason.Helsdon@excellus.com.

Picture of a mom holding a baby up over her head

Maternal Mental Health Month: Meet the Bright Beginnings team

Each year, May marks the start of Maternal Mental Health Month. According to the National Alliance on Mental Illness (NAMI), Maternal Mental Health refers to a mother’s overall emotional, social, and mental well-being, both during and after pregnancy. We recognize this month to spread awareness, support, and to encourage the availability of resources for mothers throughout the world.

7 years ago, Lyndsay is driving her newborn to the doctor’s office. As a brand-new mom, she claps her hands to check her baby’s alertness, looking repeatedly to ensure her baby is breathing during the entire 10-minute drive. Upon arriving to the office, she checks with her doctor about her concerns. They reassure her this is “typical,” just another symptom of new motherhood, or the “baby blues.” Lyndsay leaves the office feeling confused, with a feeling in her gut that something isn’t quite right.

Experiences like Lyndsay’s affect mothers worldwide. While awareness is still growing, today, we know that worldwide about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, with the most common being depression. These statistics also show a staggering health disparity for women of color. According to the U.S. Department of Health and Human Services, 30-40% of Black, Hispanic, American Indian, or Alaska Native women do not get the prenatal care they need. This is where programs like Bright Beginnings make a huge difference, stepping in to fill necessary gaps in care like transportation, resources, and provider referrals to help new parents to effectively care for themselves and their mental health.

Solutions for People Who Hate Kids' Music

As a Licensed Social Worker with the Health Plan, Lyndsay recognizes these gaps, and now works persistently to ensure members receive the care they need while pregnant or postpartum through the Bright Beginnings program. Working with individuals who need anything from resources and transportation to treatment for post-partum psychosis, Lyndsay approaches each member with respect and a listening ear.

“I say, ‘tell me your barriers. You can’t get there? Let me find telehealth. You can’t afford it? Let me find someone who does a sliding scale,’ just really trying to make sure that I’m able to give them all the resources and options that I can give them.”
-Lyndsay, Case Manager

The Bright Beginning program, led by Kara Traverse, includes a team of Licensed Social Workers and Registered Nurses who meet with members referred by area doctors and hospitals, family, and even members themselves. They contact the member, listen to their concerns, and screen for depression and anxiety. From there, the case manager assesses and makes appropriate recommendations, providing resources for transportation, education, mental health support, and more.

Above all, the Bright Beginnings team stands out as a remarkable group of compassionate and experienced health care professionals. In fact, Kara remarks that the team compiled their work experience, saying they collectively have “over 102 years of maternal health experience” on their team.

Excellus BCBS recognizes the gaps in maternal mental health awareness, and the need for more equitable healthcare for members and the community at large. The Bright Beginnings program is just one of a few programs aimed at combatting these issues. We also collaborate with community-based partners which are committed to increasing maternal health care awareness and availability. From breast pump and pregnancy education to mental health screenings and arranging visits to the hospital and pediatrician, the Bright Beginnings program enlists licensed social workers and registered nurses to help parents stay on track, caring for themselves and their children.

Excellus BCBS also supports programs for maternal mental health run by community-based organizations in our regions. Some of these efforts include: Seven Valleys Health Coalition’s Post Partum Doula Support and Doula Partnership, Contact Community Services’ Maternal Mental Health Follow Up Support, and Integrated Community Alternatives Network’s Maternal Health Equity for Pregnant Homeless Teens.

Local doctors, local decisions

Did you know that Excellus BlueCross BlueShield is supported by a team of local Medical Directors? That’s right, a team of 27 doctors who live and work right here in our communities serve as Medical Directors for the health plan. This diverse group includes medical, dental and behavioral health specialists. Their work ensures that every one of our members is receiving equitable, high-quality care that’s as affordable as possible. It’s not only a love of science and medicine that drew them into the profession, but an innate need to help, heal, and serve others.

Working with community doctors

A strong relationship with community providers is essential to providing quality care to our members. As board certified physicians with years of experience caring for patients in hospitals and outpatient settings, our Medical Directors work together with our local providers to improve quality and control costs by identifying opportunities to close gaps in care, and better controlling chronic health conditions. An example of this is our value-based payment arrangements where we reimburse doctors based on the quality of care they deliver and not just the number of services they perform. Providers can receive higher reimbursement when they meet goals around quality, experience and affordability. This is one of the ways we work with doctors to improve care while controlling costs.

This team actively collaborates with our provider partners, seeking their input and feedback in areas such as medical policy, quality improvement and medical management. This collaboration leads to improved member care and healthier communities.

Improving member wellbeing

Our Medical Directors seek out innovative opportunities to engage our members in enhancing their health and wellbeing. This dedicated group of physicians serves as advisors and leaders for dozens of initiatives. For example, in 2024 we introduced a new virtual physical therapy option to help our members manage musculoskeletal disorders from the comfort and convenience of a virtual environment. And we have partnered with a kidney care management program to help members with stage 4-5 chronic kidney disease navigate medical care services and follow their physician’s treatment plan.

A senior aged woman in her home, talking to a doctor online in a virtual appointment.

Our code of ethics

They tackle big issues such as health care disparities, rising costs, and a changing health care landscape while following a code of ethics rooted in trust. This code embraces quality and patient safety in clinical decision-making. Our Medical Directors define quality care as safe, effective, patient-centered, timely, efficient, and equitable. Their decisions are guided by evidence-based standards of care and the expertise of community providers.

Proud to live in the local area

Our Medical Director team is proud to call the upstate New York area home. You might see them out in your neighborhood enjoying time with their family, running errands, or participating in community events. Get to know our Medical Directors by visiting our website to learn more.

Educating our communities about health care (Video)

A Healthier Upstate Contributor

Common Ground Health is one of Excellus BlueCross BlueShield’s 2023 Health Equity Innovation Award recipients. Funds are used for their Get It Done program to support African American and Latino barbers and beauticians who serve as community health educators (CHEs) and peer leaders to increase health knowledge, community outreach, and increase health/mental health workshops. Support will also be provided for referrals to health care and health/social service resources.

More than 30 barber shops and beauty salons in all four quadrants of the city of Rochester take part in the Get It Done events.

Jackie Dozier, Director of Community Health and Wellbeing at Common Ground Health

“We’ve found that when people come in to get their hair done or cut, they have conversations with their stylist about whatever issues they are going through personally and professionally,” says Jackie Dozier, Director of Community Health and Wellbeing at Common Ground Health. “This is a great opportunity for stylists to educate and share health care resources and information with clients in the black and brown communities who live in the neighborhoods they serve.”

(Video) Learn more about the impact of these Get It Done events below from a salon owner and student at the University of Rochester School of Medicine and Dentistry.

Upstate Family Health Center Receives Health and Wellness Award

We recently awarded the Upstate Family Health Center (UFHC) a $5,000 Health and Wellness Award to support their Low Barrier Emergency Food Cupboard. This program was created to provide patients in need with balanced food bags for individuals presenting to the clinic in need.

“This generous donation will have a major impact in helping us meet our goal of providing our patients with balanced meals,” said Torie Hairston, senior director of integrated health at Upstate Family Health Center. “What sets this program apart is the fact that we have made the food supplies available, while eliminating barriers such as showing identification and providing documentation. This eliminates stigmas and embarrassment which can often prevent individuals from seeking help.”

UFHC created the cupboard after an evaluation of patient needs indicated a prevalence of food in-security. Food insecurity is associated with lower school performance for children, low physical activity, poor general physical health and illness, and poor mental health.

Food insecurity impacts individuals across the lifespan and can lead to anemia, cognitive problems, behavioral problems, depression, anxiety, and asthma. It is also associated with unhealthy weight control behaviors and disordered eating.

Health and Wellness Awards support programs that conduct ongoing work or initiatives designed to improve community health and health outcomes. Health disparities are complex and can have many causes. These awards are given to programs that address specific health conditions or factors linked to health disparities.

“Identifying and combatting health issues including food insecurity is core to our mission as a nonprofit health plan,” said Eve Van de Wal, Excellus BlueCross BlueShield regional president. “We are proud to present Upstate Family Health Center with community health funding to help meet their patients’ needs and provide them with essential meals and nutrition.”

Mission Moment: How our funds support our community

The Monroe County Family Coalition is one of Excellus BlueCross BlueShield’s 2023 Health Equity Innovation Award recipients. Funds will be used to provide more mental health wellness, support and education to youth and families, develop a peace garden to address food deserts and nutrition shortages in underserved communities, and enhance financial literacy and crisis support resources.

“We want to meet people where they are and make sure that no one is left behind,” says Dina Johnson, president and CEO of Monroe County Family Coalition. “Addressing inequities and health disparities in our community is vital to the success of our youth and families and we couldn’t do it without partnerships like the one we have with Excellus BlueCross BlueShield.”

Dina Johnson, president and CEO of Monroe County Family Coalition and Kimberly McKinsey-Mabry, Excellus BCBS community investments and partnerships manager.

Hear from two women who share very different experiences of how The Monroe County Family Coalition has impacted their lives.

A Healthier Upstate

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