This year, we plan to use our blog to showcase the many people that make CeltiCare the exceptional company that it is.  Recently, we had the opportunity to chat with Sean Clements, Member Service Representative.  Here is what we learned:

 What is a typical day for you?

I spend about half of my day on the phone handling calls from members and providers.  I work with customers who have questions and help direct them to the information, options and answers they need.  The questions vary and sometimes it can take a few calls with members and providers, but my ultimate goal is always to end with a satisfied member.  Sometimes the work comes from regular reports or projects, and I have also been helping out with projects related to quality assurance.

 What is it like to work at CeltiCare?

It really feels like we are all part of a big team. It is helpful to know that I have peers down the hall who are available to share tips and experiences with to help each of us be more efficient and ultimately, more helpful to our members. 

 What would people never guess you do as a Member Service Representative?

People outside the company wouldn’t expect that I get to work directly with team leads and superiors like we’re equals. Managers have an open door policy, which is great. It really helps me have an impactful role within the company in a way people might not typically expect from member service reps.

 What do you like most about CeltiCare?

I like the company’s mission to help make sure our members have the healthcare services they need.  I also like that nothing feels in vain as everything I do is helping a member or provider.

 Was there ever a time when you really felt you helped someone?

It’s hard to pick one thing because it is a daily task. Recently I worked with a member who needed a couple of bills settled, so I set aside some time to take care of her. She then reached out to me to ask about a very specific doctor that she could not get approval to see. After working in collaboration with another department, I discovered the doctor was indeed covered and the member felt saved.  Really each day is an experience in helping people.

We plan to showcase employees from throughout the company so keep an eye out for more highlights from behind the scenes!

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Last month, CeltiCare employees held a food and clothing drive for Rosie’s Place which provides emergency and long-term assistance to poor and homeless women who have nowhere else to turn. Spearheaded by Melissa Ordway of Process and Performance Support, the effort was a huge success with employees from across the company contributing food for the food pantry, winter coats, blankets, and clothing. A few employee volunteers made the trek to Rosie’s Place to deliver the items in person to the very grateful staff and clients.

Since its inception in 1974, Rosie’s Place has accepted no government funds, relying instead on committed volunteers and private supporters to deliver its mission. If you are interested in additional information on Rosie’s Place or how you can help the organization please visit their website at http://www.rosiesplace.org/.

Through our MemberConnections program, CeltiCare has been involved with Rosie’s Place for the past two years. Each month a connections representative helps members and non-members at Rosie’s Place locate quality healthcare and community social services resources available to them.

We plan to conduct more food and clothing drives in the future to support the many non-profit organizations that do so much good for our community. As we all know, this support is needed all year long and not just during the holiday season.

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We were fortunate to have an autumn filled with warm temperatures. Now the holidays are upon us and they have brought the cold weather with them. Suddenly,  it’s time to get ready for winter.  Find your boots and your shovel, but also check out some healthy winter lifestyle options. Whether it’s joining a gym, substituting something nutritious for something sweet, getting a flu shot or a health screening, there are plenty of resources available.  Here are a few tips we recommend:

• Stay active and fit by participating in a local charity run or walk.  There’s nothing better than supporting your community and maintaining a healthy lifestyle at the same time.
• Celebrate the holiday season in style, and cook for your family and friends in a healthy way!  Check out some of these nutritious and delicious recipes.
• Review the health screenings recommended based on your age, gender, family history and whether you have risk factors for certain diseases.
• Fight the flu!  It’s not too late to get a flu shot at a local clinic near you.
• Hydrate, sleep well, and relax!  Here are some ways to de-stress, unwind and enjoy the winter.

Get a jump on your New Year’s resolutions and start living a healthier life today!

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Dr. Robert LoNigro (on the right) presenting the Summit Award to Dr. Joel Gorn at the Lawrence Family Doctors office.

Last month we were proud to join in the tradition of our Centene colleagues and recognize providers who deliver high quality care to CeltiCare members with the 2011 Summit Awards for Excellence in Care.  Our first two recipients are Dr. Joel Gorn who practices at Lawrence Family Doctors and Dr. Philip Severin from the Codman Community Health Center in Dorchester. I had the privilege of presenting Dr. Gorn with his award earlier in November and look forward to presenting Dr. Severin with his award in the coming weeks. While at Dr. Gorn’s office we had the opportunity to speak with his staff and witnessed firsthand the positive energy and enthusiasm that helps makes this practice such a success.  The shrimp pizza we all enjoyed for lunch was also quite tasty!

Some people may ask, “Why are you thanking people for doing their jobs?” We choose to look at it differently.  Our mission at CeltiCare is to provide exceptional patient care and that means going above and beyond to ensure that our members are healthy and happy with their medical care experience.  We view our provider partners as part of our team and feel it is important to recognize those who not only share our core values but live them each day in their delivery of care to our members.  

If you have a provider that has gone above and beyond and want to share your experience with us, we’d love to hear about it. Please contact our Member Services Department at 1-866-895-1786 (TTY/TDD 1-866-614-1949).  I look forward to next year’s 2^nd annual Summit Awards and the formal opportunity to thank our dedicated providers for their commitment to our members’ health and well-being, something we are all grateful for each day. 

Written by Dr. Robert LoNigro, CeltiCare’s Chief Medical Director

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Last week, I had the privilege of representing CeltiCare as we donated a second 12-passenger van to the Whittier Street Health Center in Roxbury.  As many of you know Whittier has provided comprehensive health services to the community for more than 75 years and currently serves over 18,500 patients.  We first donated a van to Whittier in April 2010 and now both vans will be used to provide transportation services to patients who need assistance getting to Whittier as well as to specialty appointments at various hospitals and clinics across Boston and surrounding communities.  The van will also play a critical role in the health center’s outreach to the community through public events for health, wellness, and education.

As a Member Connections Representative, I regularly work with the patients and staff at Whittier as well as attend community meetings on site.  Together we discuss various health topics and effective ways to bring health awareness and education to the communities we serve.  In addition, we participate in different community events throughout the year to connect with those who need assistance in accessing health insurance and health care, and taking the steps to lead healthier lives.  Our members, Whittier patients, and I know that these vans will help them access the care they need.   

For the past 2 years, all of us at CeltiCare have been fortunate to see first-hand the amazing work of Frederica and her team at Whittier and we know that Whittier and the other health centers in our city and region are essential to helping patients access the high quality care they need.  We are proud to support an important community resource such as Whittier and look forward to continuing our partnership with them and other community health centers in the future. 

 Written by Brenda Saunders, CeltiCare Member Connections representative

Photo Caption: Our very own Brenda Saunders a CeltiCare Member Connections representative who regularly works with Whittier and its patients, presented the van to Frederica Williams, President and CEO of Whittier Street Health Center, and John Reardon, Chief Financial Officer of Whittier Street Health Center. 

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July marks CeltiCare’s second anniversary serving the citizens of Massachusetts.  Some highlights from our second year include:

• Growing to over 34,000 members

• Ongoing development of a network that currently includes 32 acute care hospitals, community health centers in 78 locations, and over 2,300 primary care providers and 9,500 specialists across the state.

• Extension of contracts to serve Commonwealth Care Bridge Program and Commonwealth Choice Program members.

• Participation in the state’s Patient Centered Medical Home pilot.

• Excellent member satisfaction ratings.

Throughout our two years in the Massachusetts marketplace, we have strived each day to deliver excellent service to our members and make sure they are receiving the high quality care they need and deserve.  In addition, we have traveled the state and country to share our experiences and learn from others navigating today’s complicated health care industry.

We are grateful for another year of providing Massachusetts residents with access to high quality care and appreciate the trust that our members have placed in us.

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Last weekend our CEO Richard Lynch and I had the pleasure of participating in Whittier Street Health Center’s annual Men’s Health Summit held at the Reggie Lewis Track and Athletic Center at Roxbury Community College.  Rich was a recipient of the Whittier Street Health Champions Award which annually recognizes community leaders for their outstanding work in reducing health disparities for men. He was recognized for his exemplary leadership roles as the President and CEO of CeltiCare Health Plan as well as for serving as the Board Chairman of the Whittier Street Foundation since 2009.

I was pleased to be asked to speak about the day’s theme “A Healthier Me, A Stronger You” with a panel of colleagues all dedicated to improving access to Men’s Health Care.

The Summit  – which coincided with Men’s Health Month and National Men’s Health Week – provided general information on men’s health and the importance of preventive services and screenings that are especially meaningful to men, all with the goal of raising awareness and general understanding of men’s health.  During my panel discussion, which included providers, educators, and patients, much emphasis was placed on potential reasons why men are reluctant to seek health care services. The role that men play in society, their innate need to be a provider for their loved ones, the human nature component that tends to make their own health seem less important to them than their family members’ health, a feeling of immortality, and a fear of the unknown all were highlighted as barriers to achieving good health.

Many thoughtful solutions were discussed, both in regard to the support systems available within the community to help men maintain or achieve good health, as well as the internal thinking that men need to constantly remind themselves of.  Men were reminded that in order to keep from becoming too sick to care for their loved ones, they need to participate in annual medical screening exams by their health care providers. In addition, they were reminded that an entire generation of children looks up to them, and will copy their behaviors, so practicing healthy nutrition and exercise habits is critical to ensure the health of our communities.

At CeltiCare we offer a variety of programs and outreach plans that target the specific healthcare needs of our members, including preventive services and screenings for men. Eating well, regular exercise and getting plenty of sleep are important to maintain active healthy lives. In addition screening for the presence of treatable conditions such as diabetes, high blood pressure and high cholesterol help protect us from the longer term complications of such problems Getting an Annual Wellness Exam from your PCP is a great way to receive your screening tests, AND it can provide you with an additional deposit  into your CentAccount®.

For more information on men’s health visit the websites for Men’s Health Week and Men’s Health Month.

Robert LoNigro, MD, MS, Chief Medical Director, CeltiCare Health Plan of Massachusetts, Inc.

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Results released last week from the Massachusetts Health Connector indicate that an overwhelming majority – 84% – of Commonwealth Care members are satisfied with their coverage.  

Given our participation in the Commonwealth Care program, we were pleased to see these positive results and are not surprised as they are consistent with the feedback we receive from members on a regular basis and also with the findings of a survey we commissioned in early 2010. 

Since Oct 2009, CeltiCare has also managed the Commonwealth Care Bridge Program for Massachusetts’ legal immigrants and felt it was important to obtain independent feedback on members’ experience with regard to their transition to the program and patient care experiences.  We engaged Marttila Communications to complete the survey which reported a high level of satisfaction among those members contacted for both the healthcare and customer service they had received as a member of the Bridge program.  Of particular note, our dedicated and caring member service professionals that staff our call center received exemplary ratings, reinforcing to us that our efforts to communicate with our members and assist them in overcoming any hurdles they may face in getting the healthcare and coverage they need, works!

We appreciate the feedback we’ve received from members and recognize that while it has been mostly positive, there is always room for improvement.  To that end, from our senior management team and customer service representatives to our medical management teams, all of us at CeltiCare share a sincere commitment to provide exceptional member service and continued improvement.

We are proud to be part of the Massachusetts Health Connector’s programs and will continue to work with the Commonwealth to offer all Massachusetts residents additional options for access to high-quality care.  We regard the Bridge program as evidence that with collaboration among providers, state officials and a health plan, solutions to seemingly intractable problems can be found and implemented. 

To read more about the survey results visit the Health Connector, this Boston Globe article.

Kind Regards,

Richard Lynch

President & CEO, CeltiCare Health Plan of Massachusetts

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Last week Governor Patrick announced a comprehensive health care payment and delivery reform legislation designed to control rising health care costs and improve patient care.  It continues to be an interesting time for those of us working in the healthcare industry and the pending reform locally and nationally will certainly affect us all so if you are interested in additional information you can visit the Governor’s website.  To read and listen to media coverage visit WBUR and the Boston Globe article and editorial.

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A recent piece from the Boston Globe [http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2011/01/31/a_deadly_information_gap/] got us thinking about the importance of communication in healthcare.  Not just communication between patients and doctors but communication between all parties in the healthcare experience including patients, providers, doctors, nurses and health insurers and their members.  What struck us most in this article was that the author, who detailed the challenges around navigating the healthcare system on behalf of their ill parent, was a physician.  Which begs the question, if a physician has trouble advocating for care of a loved one, how can the rest of us do it? 

All of us at CeltiCare have been patients and many of us coordinate care for loved ones whether it is a child, parent or friend.  We know that challenges exist in the healthcare system and despite the sincere efforts of a lot of great people – providers, insurers, public officials, nurses, hospital administrators – there is still a need to improve the ways in which healthcare is accessed and delivered.  While some of the challenges remain out of our immediate control, at CeltiCare we have made a commitment to communicating with our members consistently and listening to their feedback so that we can find ways to improve their experience and assist them in accessing the care they need.  

The coming months will continue to bring changes to our healthcare system as public officials discuss, debate and advance healthcare reform on the local and national level.  More on that in future blog posts but for now it is our hope that this goal of continuously improving communications is one that stays at the forefront of our collective agenda.

Kind Regards,

Richard Lynch

President & CEO, CeltiCare Health Plan of Massachusetts

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