We spoke with Karleen Haines, Chief of Community Relations at Partners Health Plan (PHP), to learn how managed care organizations like PHP are responding to the unfolding COVID-19 pandemic. PHP is a provider-led managed care organization for individuals with developmental disabilities based in New York City. As of late March 2020, New York City is the epicenter of the COVID-19 outbreak in the United States.
Karleen shared some specific steps that PHP is taking to maintain and promote health and safety during this pandemic.
Moving to remote work and utilizing virtual tools: PHP executed a teleworking policy for staffing before programs were closed in early March. They are conducting all check-ins for caseloads via Skype, FaceTime, phone calls, etc.
- PHP care managers are required to see people face to face monthly, or more, if a member is in a hospital setting. Since non-essential visitation is blocked, the PHP team will connect remotely with members, hospitals, group homes, parents, and other natural supports.
Disseminating reliable information and making it accessible for all: PHP updated their website home screen so the first thing website users see is two banners that include the basic information from the Centers for Disease Control and Prevention about COVID and the Healthy Tips and Fun Ways to Stay Connected.
- The easy-to-understand tips document was created by people with developmental disabilities for people with developmental disabilities. The original document was created by SARTAC, the Self Advocacy Resource and Technical Assistance Center. Terms like ‘social distancing’ are new, so the guide breaks down these ideas into language that makes sense.
- These resources were also promoted through social media, sent to all newsletter subscribers, and given to the care teams to share with their members and their circles of support.
- To ensure helpful items are accessible, PHP’s website is available in multiple languages. Additionally, they released the tips document as a YouTube video where it was read aloud.
Providing ideas and instructions for ways to stay connected and thriving: Many people are wondering, “How can I stay busy during this time?” PHP is sensitive to the fact that many people have lost their connections to their peers and outside world since day programs and other community sites have closed. They are building a resource center to keep people connected. This includes a list of ideas that include links to opportunities like virtual tours of local museums, dance videos, art videos, Pinterest recipes, and how to download audiobooks.
- PHP began hosting virtual gatherings on their corporate Facebook page. Upcoming gatherings will include a watch party, yoga class, and dance party.
- The goal is to keep people active and connected as a community. This isn’t just for PHP members, but for families and employees to join, too.
Being flexible and nimble to change: PHP has shifted the way they support their members. Everyday they are receiving new guidelines. Face-to-face meetings are happening virtually or telephonically. As a health plan, PHP has put additional policies in place:
- Lifted the early refill restrictions for medications so members can pick up a supply to last longer than 30 days.
- Following the DOH guide of loosening preauthorization requirements for certain urgent medical needs.
- Making IT system updates quickly to accommodate rapid changes to billing requirements.
Providing clear directions to members on how to keep in touch: PHP has been sending reminders to members to contact care managers directly. Care manager’s phone numbers are provided on the front of their ID cards and access to a 24/7 Nurse Hotline as well.
Creating resources and open communication chains for the team: PHP launched a staff communication hub, which is an internal resource that helps staff members on a professional and personal level to stay connected. They’re providing materials to keep their staff healthy, centered, and connected.
- The leadership team is meeting at the end of each day.
- Staff gather twice a week for quick “5-Minute Smile Breaks” via virtual meeting to stay connected and hear positive and supportive feedback.
Keeping enrollment open: PHP is still enrolling people despite everything that is happening. In fact, there has been an uptick in interest about the benefits of joining Partners Health Plan. It is clear that the current pandemic has prompted families and individuals to want to learn more about a managed care organization that follows a DD-centric care model. At PHP, all care managers are licensed professionals – either registered nurses or social workers. This high level of expertise likely contributes to the current increase in interest.
Keeping stakeholder meeting opportunities on the calendar in a virtual format: PHP is required to do participant advisory committee (PAC) meetings quarterly. The first meeting of 2020 was successfully conducted virtually with high participation of members and advocates.
- PHP hosts DOH-mandated ‘all member feedback sessions’ in April and October. These meetings allow members and advocates to touch base with PHP as a plan and air any concerns. They have an Ombudsman, a neutral party who is assigned to PHP by DOH, who attends the feedback sessions as well. All of this is important and is still happening – just remotely from the safety of people’s homes.
Providing 24/7 access to a doctor: PHP has a Chief Medical Officer, who is a licensed medical doctor on their staff. The care coordination teams have the support of the CMO, which means they have access to a licensed physician around the clock.
Understanding the unique needs of their population: PHP manages a specialized population, many of who are considered high-risk because of their age or medical comorbidities. PHP is sensitive to this fact and is preparing care teams to be ready to support them. PHP’s members in general need support, therapies, visits, and may need to seek medical help because of these risks.
Maintaining contact and follow-ups with individuals who live in the community: PHP checks in on community based members as soon as possible to identify if they can access medications, food, in-home aides, etc. Individuals who live in the community may require more frequent touches by their respective Care Teams as this is vital to ensure the most vulnerable members have the support they need through this pandemic.
Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration. Learn more here.