THIS IS WHAT WE’RE MADE OF. F I D E L I S C A R E N E W Y O R K A N N U A L R E P O R T 2 0 15
DEAR FRIENDS, As the health care environment continues to evolve in New York State, the experience of Fidelis Care is one that remains rooted in our core values, focused on responding to the challenges before us, and looking ahead to new opportunities. In our growth and success over the years, we have also strived to work and live in humility, grateful for all that we have accomplished, and mindful of the standards that must be met if we are to continue to fulfill the expectations of our corporate Mission. 2015 was certainly a significant year for Fidelis Care, defined by innovation, product expansion, unprecedented growth, the attainment of milestones in quality care, and dramatic change across regional markets. Each month, it seemed, brought new opportunities for Fidelis Care to embrace change, to be nimble and responsive, and to illumine a future in which many of the elements will continue to be neither fixed nor clear. There was much to do, much to reflect upon, and also much to celebrate. While the accomplishments were many, a few highlights were particularly noteworthy. For the first time ever, Fidelis Care
reached five-star status in the 2015 Consumer Guides to Medicaid and Child Health Plus Managed Care, published by the New York State Department of Health, and was recognized by the Centers for Medicare & Medicaid Services as a four-star Medicare Advantage plan. These outstanding ratings are the result of concerted efforts over time, across multiple departments, and in partnership with our providers, working together toward a common goal. Membership growth also tells a positive story. During the year, Fidelis Care grew by nearly 200,000 members. This happened through a multi-channel combination of grassroots outreach in the communities we serve, the departure of health plans in certain markets, advances in technology that made it easier for individuals to enroll online, and relationships with providers and community partners – who are often on the frontlines of care. Each of these relationships is a gateway to a better, healthier life for children, adults, and entire families across the State – from the largest cities to the most rural farmlands. This is what we believe, and this is what matters.
Fidelis Care’s culture of excellence and our commitment to view the work we do through the lens of humanity and social justice begins with our sponsors, the eight Diocesan Bishops of New York State, and our Board of Directors, who provide invaluable leadership and insight. We are immensely grateful for their time, enthusiasm, and expertise. We remain especially proud of our 3,000 employees, who embrace the Mission and all that it encompasses every day. Our Mission and Gold Award winners from the Fidelis CARE Employee Recognition Program embody what it means to have a remarkable sense of purpose for their work that transcends the routine, and inspires all. On the pages that follow, we invite you to read more about our journey in our 2015 Annual Report, This is What We’re Made Of.
Rev. Donald J. Harrington, C.M. Chairman of the Board
Rev. Patrick J. Frawley President and CEO
C O M PAS S I O N ¾ C O M M I T M EN T ¾ C O M M U N I T Y
in charitable grants and contributions
66,000 providers in Statewide network
16 community offices across New York State *3 NEW PRODUCTS TO SERVE MEMBERS:
EP, FIDA, HARP.
*ESSENTIAL PLAN, *FULLY INTEGRATED DUALS ADVANTAGE, *HEALTH AND RECOVERY PLAN/HEALTHIERLIFE
1,300,000+ members with
membership growth of nearly 200,000
1 in every 14
New York State residents is a Fidelis Care member
Oldest woman in the world is a Fidelis Care at Home member! Happy birthday, Miss Susie!
5 PETABYTES OF DATA
New corporate advertising campaign launches across all regions
(5,000 TERABYTES; 5 MILLION GIGABYTES)
Fidelis Care becomes 1st plan to offer Managed Long Term Care in
10,000 grocery vouchers for healthy, hearty holiday meals
New community offices in Rochester and Jamaica (Queens)
QUALITY CARE FOR MEMBERS
New Data Center Debuts in Buffalo
all 62 counties
NYC, Buffalo, and Albany regional offices expand
rating in NYS Consumer Guides
rating in Medicare Advantage
participation rate in Employee Satisfaction and Engagement Survey
$46.9 million AWARDED TO PROVIDERS FOR QUALITY CARE
It's a home run...
New partnership with SNY, the official television home of the New York Mets
THIS IS W H AT W E ' R E M A D E O F. 2 0 15 M I L ESTO N ES During the past year, Fidelis Care: nn Identified six key strategic areas of focus over the next five years: Data and Analytics, NCQA Accreditation, Employee Recruitment and Retention, Customer Experience, ValueBased Contracting, and Care Management Experience. nn Grew by nearly 200,000 members and achieved a 24.7 percent market share Statewide, ending the year with an enrollment of more than 1.3 million. Achieved a 20 percent market share in NY State of Health metal-level product enrollment – the highest in the State. nn Experienced record growth in the Medicare and Dual Advantage programs, adding more than 20,000 members throughout the year. nn Achieved an outstanding overall retention rate of approximately 83.4 percent. nn Responded to the needs of thousands of children and adults who were left without health insurance following the sudden exit of their health plans from local markets.
nn Met the needs of the lowincome elderly by becoming the first health plan to offer Managed Long Term Care in all 62 counties, with the expansion of Fidelis Care at Home. Expanded Fidelis Medicare Advantage into 10 new counties and Dual Advantage into 19 new counties. nn Launched three new programs to serve members: Fully Integrated Duals Advantage (FIDA); HealthierLife, a Health and Recovery Plan (HARP); and the Essential Plan (EP). nn Achieved the highest rating of five stars in the Consumer Guides to Medicaid and Child Health Plus Managed Care published by the New York State Department of Health. nn Achieved a four-star rating from the Centers for Medicare & Medicaid Services (CMS) for the provision of quality care and services for our Medicare Advantage and Dual Advantage members. nn Partnered with more than 66,000 providers in our Statewide network to serve members. nn Awarded providers approximately $46.9 million for the provision of quality care through our Quality Care Management Incentive (QCMI) program. nn Transitioned to the new ICD-10 medical coding system to be fully compliant with the federal government’s October 1 deadline.
nn Supported wellness and routine care with nearly $400,000 in incentives for members. nn Began the process of achieving NCQA accreditation – a milestone that will demonstrate Fidelis Care’s compliance with the rigorous standards of the most widely recognized accreditation program in the country. nn Opened new community offices in Jamaica (Queens) and Rochester to serve local members and residents. nn Expanded regional office space in New York City, Buffalo, and Albany. nn Opened a new Data Center in the Buffalo Regional Office. nn Experienced the highest-ever participation rate in the Employee Satisfaction and Engagement Survey at 92 percent. nn Provided more than $3 million in charitable grants and contributions for health initiatives and outreach in underserved communities, including $2.5 million through the Community Grant Fund. nn Distributed nearly 10,000 vouchers for groceries to help needy families have a healthy, hearty meal for the holidays. nn Debuted a Statewide, multimedia advertising campaign to promote and extend the Fidelis Care brand.
FINANCIAL P E R F O R M A N C E 2 0 15
* FIDELIS CARE AND SUBSIDIARIES
* FIDELIS CARE AND SUBSIDIARIES
NE T WORK AND MEMBERSHIP GROW TH PERFORM ANCE ME ASURE
NUMBER OF PROVIDERS
NUMBER OF COUNTIES MEDICAID MANAGED CARE CHILD HE ALTH PLUS
FULLY INTEGRATED DUALS ADVANTAGE HE ALTH AND RECOVERY PL AN MEDICARE & DUAL ADVANTAGE FIDELIS CARE AT HOME FIDELIS MEDICAID ADVANTAGE PLUS NY STATE OF HE ALTH ME TAL-LE VEL
2 0 15: THE YEAR IN REVIEW
¾ Strategic Initiatives At the beginning of the year, members of Fidelis Care’s leadership team embarked on a five-year process to assess, strengthen, and chart a course for success in six core areas that were identified as critical for Fidelis Care's continued success: Data and Analytics, NCQA Accreditation, Value-Based Contracting, Customer Experience, Employee Recruitment and Retention, and Care Management Experience. Progress was tracked and plans were developed throughout the year for a multitude of interdisciplinary initiatives that are designed to support members and providers, streamline business operations, assess our brand strength and identity, and position Fidelis Care for the future. For each of the core areas, an assessment was made on where we stand currently, where we want and need to be, and the resources that will be needed to get us there.
¾ The Cornerstone of Quality Care At the heart of Fidelis Care’s work has always been a commitment to the provision of quality care for members. This includes preventive care like immunizations and well child exams, breast cancer, colorectal cancer, and osteoporosis screenings, diabetes
management, flu shots, and more. Aligned with State and national standards, Fidelis Care’s focus on quality health care for members often begins in the provider’s office. Each year, we undertake a variety of initiatives to encourage and foster the vital relationship between members and providers. Illustrative of our commitment in this area, Fidelis Care secured a five-star rating in the 2015 Consumer Guides to Medicaid and Child Health Plus Managed Care, published by the New York State Department of Health. The five-star rating for Fidelis Care is the highest achievable and represents an increase from four stars in 2014. The ratings are based on measures such as preventive and well care, quality of care, and member satisfaction. Only one other plan in the State earned the same distinction. Similarly, Fidelis Medicare Advantage was recognized as a four-star plan by the Centers for Medicare & Medicaid Services (CMS), based on the quality of care and service provided to members. The Medicare Star Rating system reflects 48 measures related to quality, member satisfaction, and access to care, among several others. It is also important to note that Fidelis Care received a 4.5 star rating for our Part D Prescription Drug Program.
Achieving four stars was a significant accomplishment because the rating promotes ongoing membership growth and retention, and identifies Fidelis Care as a health plan that meets nationally recognized quality standards. It also demonstrated significant progress toward our goal of being a five-star Medicare Advantage plan.
¾ Incentives Awarded to Providers, Members The Quality Care Management Incentive (QCMI) program is at the center of Fidelis Care's quality initiatives. Each year, the QCMI program is based upon recognized State and national guidelines from the State Department of Health’s Quality Assurance Reporting Requirements (QARR) and the National Committee on Quality Assurance (NCQA). In 2015, Fidelis Care awarded providers approximately $46.9 million in incentives for the provision of quality care to members in the prior year. Fidelis Care members were also awarded approximately $400,000 in incentives for the care they received in areas such as childhood wellness, BabyCare, behavioral health, women’s health, osteoporosis management, and diabetes training.
¾ Planning for NCQA Accreditation In the spring, Fidelis Care embarked on a multi-year process to achieve accreditation from the NCQA – a nationally recognized evaluation that reviews the quality of care provided to a health plan’s members. To earn accreditation, NCQA evaluates how well a health plan manages all parts of its delivery system, which covers providers, hospitals, and administrative services. NCQA accreditation provides consumers with the ability to evaluate the quality of health plans and to make decisions based on demonstrated value rather than simply on cost. In 2015, Fidelis Care began the interim accreditation process as the first step on the path to achieve full accreditation, which is estimated to be in October 2017.
¾ Product and Geographic Expansion Several notable additions and expansions during the year enhanced Fidelis Care's product portfolio and strengthened our ability to serve a diverse membership with a variety of health care needs.
Fidelis Care at Home (FCAH): Fidelis Care became the first health plan to offer Managed Long Term Care (MLTC) in all 62 counties of the State, after approval was received from the State Department of Health to expand the FCAH product in the final 12 counties where we had not been operational – primarily across the North Country, Southern Tier, Finger Lakes, and Central regions. By the end of the year, FCAH had a membership of more than 11,000. One of the highlights during the year was the birthday of the oldest woman in the world, 116-year-old Susie Jones, a Fidelis Care at Home member who lives in Brooklyn. FCAH staff were on hand with Miss Susie's family and friends for the celebration. Essential Plan (EP): In the fall, Fidelis Care prepared for implementation of the new Essential Plan offered through NY State of Health, which replaced the Silver 150 and Silver 200 metal-level products. Designed for lower-income adults ages 19-64 who are not eligible for Medicaid or Child Health Plus, EP features year-round enrollment, with monthly premiums of $0 or $20 based on income. Initial interest and enrollment in the EP product were strong, as Fidelis Care had 70,000 members for January 1, 2016 coverage.
HealthierLife: A new Health and Recovery Plan (HARP) called HealthierLife was implemented for eligible members in New York City on October 1. The focus of HealthierLife is to provide additional assistance and resources to individuals with serious mental illness and/or substance use disorders diagnoses. In November, Fidelis Care received conditional approval for HealthierLife to expand in the rest of the State. On a related topic, Fidelis Care and other managed care plans began managing expanded behavioral health benefits for Medicaid members as of October 1. Also at that time, members whose behavioral health benefit was covered under Fee for Service Medicaid through SSI began to receive those benefits through Fidelis Care as well. Fully Integrated Duals Advantage (FIDA): Fidelis Care was one of 22 health plans selected by the State Department of Health to serve enrollees who have Medicare and Medicaid coverage and are eligible for community-based long term care services. The goal of FIDA, which launched on January 1 in New York City and Nassau County, is to simplify access to care and improve care coordination for members. By the end of the year, Fidelis Care had nearly 300 FIDA members.
Medicare Advantage: As part of our geographic growth, Fidelis Care expanded the Fidelis Medicare Advantage program into 10 new counties, and the Dual Advantage program into 19 new counties.
process for those who had not selected a plan for December 1. Through this process, as well as our own proactive outreach, Fidelis Care implemented a variety of initiatives to enroll Health Republic members before the December 15 deadline for January 1, 2016 coverage.
¾ Membership Growth
In the Buffalo Region, Independent Health (IHA) announced in late fall that it would no longer provide Medicaid Managed Care in Niagara County, leaving 15,000 members to find coverage with a new plan by the end of the year. Through extensive community outreach and working closely on special enrollment sessions with local providers, Fidelis Care enrolled approximately 8,300 of the former IHA members.
During the year, Fidelis Care’s membership grew by close to 200,000, which led to the achievement of a 24.7 percent market share Statewide, and a total enrollment of more than 1.3 million. A variety of factors, including our own strategic initiatives as well as unexpected changes in regional markets, dramatically impacted the opportunities to reach new populations of individuals who were seeking health insurance coverage for either themselves or their families. Perhaps the most notable of these factors was the sudden exit of Health Republic Insurance of New York, the largest nonprofit cooperative, which was shut down by the State Department of Financial Services and the NY State of Health Marketplace effective November 30. To help ensure coverage and continuity of care for the more than 70,000 Health Republic members with individual coverage who were impacted, Fidelis Care worked with the State on an auto enrollment
Overall, for 2015 coverage through the Marketplace, Fidelis Care ranked first among 20 health plans, securing 20 percent of the metal-level product enrollment. This marked an increase of three percent from 2014. During the past year, Fidelis Care also became one of the fastestgrowing Medicare Advantage plans in the State, with a membership growth of more than 20,000 and a total membership of more than 46,000. Community Offices: Throughout the year, Fidelis Care’s communitybased offices continued to be a growing focal point of our initiatives
to serve current members, as well as local residents in need of health insurance. By year’s end, Fidelis Care had 16 community offices Statewide, including our two newest locations: Jamaica (Queens) and Rochester (Monroe County). Both offices held ribbon-cutting events in October, attended by Fidelis Care staff, community partners, and local dignitaries. Our mascot, Fidelisaurus, was also on hand to welcome visitors to each location, and in Jamaica, Mr. Met’s surprise visit was a big hit. The Chinatown office, long established in the community, was relocated to a more spacious and convenient location, and the Spring Valley office in Rockland County also relocated to new space in the same shopping mall. Each of the community offices was staffed by a Retention Services Advocate – a new position that was created to improve the customer experience and provide a full complement of enrollment and retention services to members and visitors. Across the State, Fidelis Care’s community offices served more than 214,000 walk-ins, and were responsible for approximately 30,000 enrollments. Additional community office locations are planned for 2016. Affordable Care Advisor: Two years ago, Fidelis Care implemented a new initiative that provided
individuals with the ability to get a quote through an online tool called the Affordable Care Advisor, which is featured on our website, and had been installed on kiosks conveniently located in shopping malls in targeted locations. In 2015, two new mall locations were added, bringing the kiosk total to five across the State. The program continued to be successful, with more than 22,400 unique users receiving quotes for their health insurance – all in 60 seconds or less.
¾ Working with Providers With more than 66,000 providers in our network, Fidelis Care engaged in several initiatives to promote our ongoing relationship as partners in quality health care access and service. As one of these initiatives, Fidelis Care launched a redesigned Provider Portal in February. While there were some enhancements to the look and feel of the Portal, the majority of changes focused on a new security and user account methodology. The new Portal featured mobile-friendly design, a new home page layout, additional controls for account administrators, enhanced security features, and improved search capabilities.
ICD-10: In preparation for ICD-10, a medical coding system of more than 14,400 codes used throughout the world, a dedicated team of Fidelis Care staff members worked throughout the year to ensure a smooth transition and full compliance by the October 1 deadline set by the federal government.
¾ Value-Based Contracting Dating back to 2011, part of the State’s Medicaid Redesign Team (MRT) plan was to obtain a waiver that would allow the State to reinvest $8 billion in federal savings generated by MRT reforms. Finalized with the federal government in April 2014, the waiver amendment is designed to address critical issues throughout the State and allow for comprehensive reform through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program is described by the State as the “largest effort to transform the Medicaid delivery system” through community-level collaborations and a focus on system reform. The key objective of DSRIP is to reduce avoidable hospital stays by 25 percent over five years. This goal will be attained through provider contracting models that will transform fee-for-service reimbursement into value-based payment (VBP) methodologies. Fidelis Care worked throughout 2015 to develop a VBP contracting model
that will meet the five-year goal of DSRIP in converting 90 percent of managed care payments to providers into VBP methodologies.
¾ Information Technology In 2015, Fidelis Care implemented two major releases for Salesforce, our Customer Relationship Management application. The first involved the integration with Facets for member data in April. As part of our continuing efforts to streamline workflow, Transportation Services was added to Salesforce in late October, providing for enhanced vendor relationship management, custom vendor searches, and increased automation. Enhanced IT Security: In 2011, Fidelis Care started an Information Security team with just one member. Four years later, there was a 15-member team overseeing security operations. Throughout the year, Fidelis Care's Security team provided additional training for employees and implemented new protocols based on best practices, as well as on reviewing and assessing the data breaches that had been reported by other health insurance companies. Fidelis Care employees received information on how to spot phishing and other hacker scams. Guidelines for Protected Health Information (PHI) also were reviewed, and an
adjustment was made to enable our secure mail platform to automatically send any unsecure emails that appeared to contain PHI to the secure messaging system. Among other initiatives, the Security team also implemented two-factor VPN authentication for remote access users, and an emergency contact card in case an employee lost or misplaced a laptop or smart phone. New Data Center: A new Data Center at 490 CrossPoint opened for processing beginning on April 10. IT staff worked diligently over several months to move servers from two locations located at the PCI Data Center and 480 CrossPoint to the new state-ofthe-art location, which houses 1,500 computer servers.
¾ Communications Initiatives To provide a baseline understanding of the brand image of Fidelis Care across the State, a vendor was selected in late summer to conduct an online survey with Fidelis Care members, as well as with members of other health plans in each region. The goal of the study was for Fidelis Care to further refine a brand identity strategy based on who we are, how we perform, why people choose and stay with us as a health plan, and what our plan stands for.
The study revealed that the overall brand image of Fidelis Care is solid, but there is a need to build greater consistency and cohesiveness across the regions. Interestingly, respondents identified the ideal health plan as being a caring company that is passionate, smart, and neighborly. While there is no one health insurance company identified as behaving exactly the way that members say they want it to, Fidelis Care comes closest to the ideal, and we have a significant opportunity to differentiate ourselves from other plans in this regard. As part of our branding initiatives, Fidelis Care launched a new corporate advertising campaign based on the theme, “This is what we’re made of.” The multimedia campaign launched in the fall and featured TV, radio, high visibility outdoor and digital billboard locations, transit, and social media advertising across all regions. Unique opportunities for placement included three “station domination” locations in New York City at selected subways, a digital billboard “spectacular” across from Madison Square Garden on 7th Avenue, and a public relations opportunity with Univision, the flagship station of the Spanishlanguage television network Univision Communications, which broadcast live during the evening news from Fidelis Care’s Call Center to highlight the beginning of open enrollment.
We also continued our partnership with the WNBA’s New York Liberty, which focused on grassroots community outreach in key neighborhoods, and included a sponsorship of the team’s popular senior dance group, the Timeless Torches. A new relationship with SportsNet New York (SNY) brought a variety of opportunities for advertising and public relations, particularly during New York Mets games.
¾ Human Resources Highlights With a record-high 92 percent participation rate, the 2015 Employee Survey results showed that Fidelis Care employees are overwhelmingly proud to work for the company, and continue to be motivated and inspired by their connection to the corporate Mission. Further, the high participation rate demonstrated that employees see the direct relationship between the feedback they provide on the survey, and the actions taken by Fidelis Care leadership to enhance and improve upon the employee experience. Other areas of strength identified in the survey were the organization’s commitment to quality and customer focus, supervisor-employee relationships, performance management, and enhanced communication with senior leadership. Areas of opportunity included: communication within and between departments, processes, 10
procedures, and technology to support the company’s growth, and individual opportunities for growth and development. Professional and career development for all staff was a focal point during the year, as Human Resources developed and facilitated 13 new classes for employees and managers, published an online training calendar and course descriptions, offered 53 Microsoft training sessions, launched a revised new employee orientation program, and developed targeted management training programs. Additionally, the talent management platform, Taleo, was fully launched in the fall to promote and streamline the recruitment of top talent, and facilitate a positive experience for job seekers at Fidelis Care. Highlighting the dedication of employees was the focal point of a new initiative called “Be the Mission,” which was showcased on myfidelis and our social media networks such as Facebook and Twitter. The “Be the Mission” graphic series featured employees who inspired members, providers, or community partners to share their positive experience through a phone call or letter to Fidelis Care. More than 20 employees were profiled through the series during 2015. To promote a healthy worklife balance and in response to
employee survey feedback, Fidelis Care launched a new wellness program on myfidelis called HealthyYou, designed to help employees make healthier and smarter lifestyle choices. Throughout the year, HealthyYou provided a variety of activities, resources, and information for employees to access at their convenience. Another new initiative for staff was the introduction of the EveryMove @Work program, which enabled employees to log activities – from gardening to bike racing – either manually or through a fitness tracker. Employees earned points based on their activity level and were eligible for rewards. Several friendly competitions between departments and regions fostered participation in EveryMove throughout the year. As a related activity, Fidelis Care fielded teams in corporate and workforce challenge running events in each region.
¾ Facilities Expansion In 2015, key expansion projects were completed to provide Fidelis Care with the ability to accommodate the company’s growth. In the Buffalo Region, more than 160 employees settled in to the new Call Center at 490 CrossPoint Parkway, adjacent to
the original building. The move by the Call Center employees in January was the culmination of a yearlong expansion project that saw the addition of an 87,000square-foot building with room for 700 employees. The dining area at 480 CrossPoint was also expanded, and new cubicles in a “honeycomb” configuration, replaced old work stations on the third floor. In the New York City Region, the 10th floor was expanded to provide space for approximately 90 staff members, primarily from the Retention Department. In the fall, Fidelis Care at Home staff moved to new space at 97-77 Queens Boulevard. Approximately 10,000 square feet of space were added to the Albany Region office, providing for 343 staff members. The dining area for staff was also expanded and enhanced.
¾ Giving Back Fidelis Care provided more than $3 million in charitable grants and contributions for health initiatives and outreach in underserved communities, including $2.5 million through the Community Grant Fund. Support went to Diocesan initiatives such as educational programs, emergency food pantry assistance, and family services offered by Catholic Charities,
programs to reduce unnecessary emergency room visits, and outreach to migrant families. With providers at the forefront of reaching those most in need, discretionary grants supported vital, community-based health initiatives such as equipment for a new geriatric inpatient unit, hearing screenings, and other programs designed to improve access to care. Through the Catholic Schools Grant Fund, Fidelis Care awarded about $500,000 to support school-based personal growth, moral development, and health programs. In the communities we serve, Fidelis Care took every opportunity to reach individuals of all ages and from all walks of life who needed health insurance. Provider office and community partner locations were staffed regularly by Fidelis Care Health Benefit Representatives who were on hand to help local residents learn about their options and apply for coverage. Fidelis Care sponsored hundreds of events throughout the year, participated in food and clothing drives, and donated nearly 10,000 grocery vouchers to help those in need have a hearty, healthy holiday meal.
¾ Employee Recognition Through the Fidelis CARE Employee Recognition program, we acknowledge and reward staff each year whose performance and commitment are exemplary, and who go “above and beyond” in areas such as: C = Customer Service, Creativity, Communication A = Appreciation for Quality Service R = Respect for Innovation and Change E = Empathy for our members and Enthusiasm for Fidelis Care The Gold Award recognizes staff for continuous noteworthy performance in the achievement of Fidelis Care’s success, while the Mission Award recognizes an individual who is collaborative, visionary, and goes beyond the normal boundaries of his or her position. The profiles on the following pages illustrate the special dedication and unique spirit that our most recent Mission and Gold Award winners bring to their work every day.
FIDELIS CARE EMPLOYEE RECOGNITION PROGR AM
¾ MISSION AWARD
NEZIR JASAREVIC HE ALTH BENEFIT REPRESENTATIVE, MARKE TING
¾ “My greatest accomplishment is that people in the community recognize I am here to help. The Fidelis Care Mission guides me every day, and people respond to those values.”
More than 20 years after coming to the United States as a refugee from Bosnia, Nezir Jasarevic still remembers the struggles of leaving his home and starting over in a strange land. Those powerful memories guide him every day as a Fidelis Care Health Benefit Representative. Nezir understands refugees’ worries and makes it his goal to ease their fears. His 15-year career at Fidelis Care is built on trust and strong relationships with members and organizations, including the Mohawk Valley Resource Center for Refugees, St. Elizabeth Medical Center, and the Rescue Mission of Utica. “My greatest accomplishment is that people in the community recognize I am here to help,” Nezir said. “The Fidelis Care Mission guides me every day, and people respond to those values.” Nezir is known throughout Oneida County as the “face of Fidelis Care” and as a person you can rely on. He makes it a point to go wherever he is needed. In addition to his many outreach sites, he attends events during nights and weekends to reach those in need. His dedication is a primary reason that Fidelis Care’s market share for Medicaid Managed Care and Child Health Plus reached 71.5 percent in the county in 2015. Nezir is constantly looking for outreach opportunities. When the Oneida County Department
of Social Services decided to hold Medicaid information sessions as far back as 2000, Nezir made sure Fidelis Care was well represented. When the focus of the sessions changed to also reflect NY State of Health enrollment, Nezir adapted easily, educating potential members on Fidelis Care’s many options. He also explained to Medicaid members about the need for a primary care provider and walked them through the process. “Some people, especially refugees, may not understand the concept of health insurance and why they need it,” Nezir said. “I can help them with this important step, which relieves a tremendous amount of stress in their lives.” Nezir’s work in helping members renew their health insurance is another testament to his abilities. He is dedicated to providing the same level of service that he would want for himself. Fidelis Care’s commitment to members makes his achievements possible, he said. “Our Mission remains the same as it has always been,” Nezir said. “Fidelis Care’s strong foundation has enabled the company to grow and succeed.” Nezir’s translation skills also have been a valuable resource. In addition to helping nonEnglish-speaking members and prospective members in Oneida County, he travels to Onondaga and other neighboring counties to work with people who have
difficulty understanding English. He also serves as a resource to interpreters in the region, helping to teach them about health insurance. “Nezir is always enthusiastic about his job,” said Tom Julian, Director, Marketing. “He treats everybody with an immense level of caring and respect, and goes out of his way to help others.” Nezir is thankful for a strong support system that includes Tom Julian; Gina Price, Manager, Marketing; Nicole Patrei, Supervisor, Marketing; and other managers and colleagues. He credits them for giving him the opportunity to succeed. “Fidelis Care is my family,” he said. “I trust them fully. When you have great support, you can do your best.”
¾ Nezir lives in Oriskany, Oneida County, with his wife, Azira, and their two children. He is based out of Fidelis Care’s Syracuse office.
FIDELIS CARE EMPLOYEE RECOGNITION PROGR AM
¾ GOLD AWARD
COURTNEY GAGNON SENIOR CONTR ACT MANAGEMENT REPRESENTATIVE, CONTR ACT MANAGEMENT
¾ “I strive to develop and maintain networks that are not just adequate, but exceptional."
After only two years at Fidelis Care, Senior Contract Management Representative Courtney Gagnon has become known as an integral member of her department, playing major roles in the implementation of HealthierLife, Fidelis Care’s new Health and Recovery Plan (HARP), and the Statewide expansion of Fidelis Care at Home, the company’s Managed Long Term Care (MLTC) product. “The HealthierLife implementation and the Fidelis Care at Home expansion were tremendous accomplishments for the company,” Courtney said. “I was proud to be involved and help our provider network grow.” With HealthierLife, a program for people with behavioral health or substance abuse issues, Courtney worked closely with contacts at the New York State Department of Health (SDOH), the Office of Mental Health (OMH), the Office of Alcohol and Substance Abuse Services (OASAS), and new and existing providers to help establish the program at Fidelis Care. When contracting with providers, Courtney focused on making sure they were familiar with Fidelis Care’s products and Mission. For her strong efforts in representing Fidelis Care during meetings across the State, Courtney was praised by leaders of the Managed Care Technical Assistance Center of New York (MCTAC), an agency contracted
by the State to facilitate the HARP transition. Providers saw her as a subject matter expert on the new program because of her breadth of knowledge and consistent presence and engagement. Courtney also was a key member of the Fidelis HARP Steering Committee, a multi-disciplinary group that worked to meet the requirements set by SDOH. She helped train Contract Management employees on how to sign up new providers, many of whom had never been involved with managed care organizations. “Courtney helped providers feel comfortable coming in to the Fidelis Care network,” said Dani Heifetz, LCSW, Assistant Vice President, Behavioral Health Services. “Her knowledge, focus, and patience were reassuring and helped to create a robust HARP network.” Courtney’s ability to embrace new opportunities was also seen during the expansion of Fidelis Care at Home into the 12 remaining counties in the State. The threemonth process involved building a network that met SDOH’s standards, even in rural areas served by fewer providers. “I strive to develop and maintain networks that are not just adequate, but exceptional,” Courtney said. In addition to those high-profile projects, Courtney also excelled in maintaining strong relationships
with the provider networks she was assigned to work with on routine contract issues. “I owe my success at Fidelis Care to the support of Louise Donato, Director, Contract Management, and my co-workers,” Courtney said. “They are always there and willing to help.”
¾ Courtney lives in Saratoga Springs, Saratoga County, with her family. She is based out of Fidelis Care’s Albany office.
FIDELIS CARE EMPLOYEE RECOGNITION PROGR AM
¾ GOLD AWARD
MELISSA MATA SUPERVISOR, QUALIT Y ASSUR ANCE, MEMBER SERVICES
¾ “The responsibility is on us to show we care. My team and I are constantly reviewing audits to learn how to give our members an even more positive experience.”
Melissa Mata is always looking for ways to improve members’ experiences with Fidelis Care. As Supervisor, Quality Assurance, Melissa oversees the company’s Quality Improvement Specialists and Associate Operational Auditors, who monitor the Call Center to ensure members are receiving the best possible support. “The responsibility is on us to show we care,” explained Melissa, who joined Fidelis Care two and a half years ago. “My team and I are constantly reviewing audits to learn how to give our members an even more positive experience.” To improve the Call Center audit process, Melissa helped design a system that automatically assigns calls to Associate Operational Auditors for review. Prior to the new system, an Associate Operational Auditor had to spend time manually assigning the calls. The change has boosted the department’s efficiency. Each Member Services Associate now receives nine audits a month, up from six audits previously. To keep up with the changes in health care, Melissa cited the importance of ongoing training. Audit reports and staff feedback allow her to identify certain trends, such as an issue with validation of members’ identities. The Department can then provide necessary coaching to staff members. Melissa also has
stepped in to help with the training of new employees. “We have to be prepared for any situation,” Melissa said. “A lot of times we encounter members when they are going through a difficult time. We have to be empathetic and put ourselves in their shoes.” Melissa also helped to shepherd audit delivery improvements that have encouraged collaboration between Associate Operational Auditors and Member Services Associates. Audits are now immediately accessible to employees, and the Associate Operational Auditors work directly with the Member Services Associates to help them with any issues. Her methodology has been embraced by employees and helped to further strengthen the department’s bonds. “Melissa is a natural leader who inspires others to perform at their highest level,” said Natalie Wagner, Director, Operational Performance Improvement. “She always wants to help staff find the best ways to achieve member satisfaction.” Melissa, who started as a Member Services Associate before being promoted to Quality Insurance Specialist in April 2014 and Supervisor, Quality Assurance in May 2015, also works directly with members. When a member has a question or concern on Facebook, Twitter, or another of Fidelis Care’s
social media accounts, Melissa is contacted by the Communications Department for assistance. She and her team identify the member, research the situation, and contact the member to resolve the issue. Whether it’s working with one member or implementing policies that affect thousands, Melissa is proud to be part of Fidelis Care’s Mission. “It impacts everything I do. I am always thinking of the member,” she said. Melissa credits her success to the support and guidance she has received from her team and the leadership of Natalie Wagner; Jesse Silva, Manager, Member Services; and John Galvez, Assistant Vice President, Member Services.
¾ Melissa lives in Glendale, Queens County, with her husband, Onix. She is based out of Fidelis Care's New York City office.
FIDELIS CARE EMPLOYEE RECOGNITION PROGR AM
¾ GOLD AWARD
ELIZABETH McALLISTER MANAGER, MEDICAL CODING, CL AIMS
¾ “My team was dedicated to finding solutions to any issues that arose. We worked alongside other departments to ensure a seamless transition.”
Even though Elizabeth McAllister, Manager, Medical Coding, works primarily with numbers, the faces and stories of Fidelis Care members are foremost on her mind. “When I’m working at my computer on medical coding issues, I really feel like I’m working with our members,” Elizabeth said. “I think of how I’m helping the mother of a sick child, or the son of an elderly parent who needs care. It’s personal to me.” Elizabeth’s diligence in regard to medical claims coding ensures members receive the care and services they need. She and her team of 10 Certified Medical Coders help to translate new procedure codes into their appropriate classifications, and then work with other departments to confirm benefits are available. “We try to get in front of any changes, so staff on the frontlines have the answers they need,” said Elizabeth, who has been with Fidelis Care for two and a half years. “It’s important that we always give our members and providers an excellent experience.” Over the past year, Elizabeth and her team faced a major undertaking when they helped transition Fidelis Care from the International Classification of Diseases, 9th revision (ICD-9) to the new ICD-10 code set. Approximately 88,000 diagnosis codes needed to be translated before the October 1
deadline set by the federal government. Her team had to find solutions for significant shifts in some codes. For example, there were some instances in which a single ICD-9 code had more than a dozen translations in ICD-10. “My team was dedicated to finding solutions to any issues that arose,” Elizabeth said. “We worked alongside other departments to ensure a seamless transition.” One way Elizabeth guaranteed Fidelis Care’s success was by organizing a four-day ICD-10 training program for her team and members of the QHCM, Finance, and IT departments. A trainer from the AAPC, a national organization that focuses on medical coding, worked with Fidelis Care employees to explain the ICD-10 code set and answer questions. Attendees found the program to be extremely beneficial. “Elizabeth was instrumental in the successful implementation of ICD-10,” said Alicia Delmont, Vice President, Claims. “Her teamwork and service were extraordinary.” Elizabeth also was heavily involved in updates to the Facets Clinical Editor, which improved the claims processing software’s functionality and accuracy by automating certain features. The Medicare Risk Adjustment Chart Review was another project that Elizabeth took great pride in
overseeing, especially as Fidelis Care’s Medicare enrollment grew to more than 46,000 members in 2015. The annual audit, which requires one complete chart review for every Medicare member, ensures we are fulfilling the company’s mission to provide exemplary care, she explained. “Our Mission Statement isn’t just a thing on the wall; helping people is what we are made of,” Elizabeth said. “It makes me feel proud to go to work every day.”
¾ Elizabeth lives in Williamsville, Erie County, with her husband, Bruce, and their two sons. She is based out of Fidelis Care’s Buffalo office.
FIDELIS CARE EMPLOYEE RECOGNITION PROGR AM
¾ GOLD AWARD
MOHAMMAD “MO” SEPEHRRAD MANAGER, QUALIT Y ASSUR ANCE, INFORMATION TECHNOLOGY
¾ “Maintaining a high level of quality is very important. It shows Fidelis Care’s commitment to providing a great experience to members and providers.”
For Mohammad “Mo” Sepehrrad, the key to success is collaboration. As Manager, Quality Assurance, Mo works hand in hand with Information Technology (IT) Business Analysts and Developers, as well as employees from other departments at the onset of new projects. He and his team perform extensive tests and find solutions to ensure the projects’ successful implementation. His goal is to resolve any concerns before they impact the company and members. “Maintaining a high level of quality is very important,” said Mo, who joined Fidelis Care nearly two years ago. “It shows Fidelis Care’s commitment to providing a great experience to members and providers.” Mo participates in project meetings, reviews his team’s work, and determines which projects need closer attention. His strong organizational skills helped guide his team to success on several initiatives, including updates to NY State of Health: The Official Health Plan Marketplace products and the implementation of the International Classification of Diseases, 10th revision (ICD-10) code set. With NY State of Health, he worked closely with Enrollment to ensure new and returning members would have a worry-free experience. For the ICD-10 transition, Mo provided testing support to the IT and
Claims departments by creating thousands of test claims to run through Fidelis Care’s systems. “User Acceptance Testing is a critical part of quality assurance,” Mo explained. “It’s not enough for a project to meet IT standards; we want to make sure it will meet the day-to-day needs of each department using the application.” To continually improve quality assurance, Mo advocated for the adoption of Application Lifecycle Management (ALM) software to manage projects. Numerous teams on more than 30 projects have now used the software, which manages requirements, test cases, defects, and reporting. Mo also is a proponent of automating processes. For example, he and his team developed a script to validate electronic claims from CVS/Caremark, our pharmacy vendor. By implementing the script, Fidelis Care is now able to perform a full file validation instead of a sample, and in less time than before. Another script examines provider agreements to validate providers’ tax ID numbers. “Mo has proven to be an indispensable resource to Fidelis Care,” said Kathleen Velasquez, Director, IT Business Analysis and Quality Assurance. “He is continuously sought out for his expertise and knowledge, and always puts the company first.”
Mo is appreciative of the support he has received from senior leadership, and added that they have always been responsive to suggestions such as the ALM adoption. “From day one, senior management has been committed to quality improvement,” Mo said. “Anything I brought to the table was looked at and supported.” Knowing his team’s efforts make a difference in people’s lives means a lot to Mo. “It feels good to work here and to help people in need,” he said. “I feel blessed to have a great team and be part of Fidelis Care.”
¾ Mo lives in Tonawanda, Erie County, with his wife, Heather, and their daughter. He is based out of Fidelis Care's Buffalo office.
FIDELIS CARE EMPLOYEE RECOGNITION PROGR AM
¾ GOLD AWARD
LYNN TRAN SUPERVISOR, PHARMACIST, PHARMACY
¾ “Not every medication is right for every member. There might be better alternatives for some people. It’s our duty to find those solutions.”
Lynn Tran, Pharm.D., Supervisor, Pharmacist, is committed to changing people’s lives for the better. Her proactive approach to health care has allowed thousands of Fidelis Care members to get the medications they need and the care they deserve. Because several of Lynn’s projects and initiatives involve newly developed medications, she focuses on ensuring members respond positively to them. “We want members to take their medications correctly,” said Lynn. “We offer support and guidance so they get the best results.” One of Lynn’s key initiatives in 2015 was a drug utilization review of Suboxone, a medication that is often used to treat addiction to prescription painkillers and other opioids. Lynn and her team studied the utilization of Suboxone and created a strategy to confirm appropriate use of the medication. She then worked with Fidelis Care Medical Directors, Communications staff, and providers to develop member communications. She also urged providers to implement laboratory monitoring of members when necessary. By creating safeguards in Suboxone treatment, Fidelis Care was able to limit restrictions on the medication without delaying member care. “We are one of the few Medicaid plans in New York State that doesn’t require a prior authorization for Suboxone,”
Lynn said. “We want to make it easy for members to seek and receive addiction treatment.” Another area where Lynn collaborates with providers is in finding safe treatment alternatives for members when they have adverse reactions to medications. For example, some medications can reduce the potency of another medication the member is taking, she explained. “Not every medication is right for every member,” Lynn said. “There might be better alternatives for some people. It’s our duty to find those solutions.” Fidelis Care’s Hepatitis C program has also benefited from Lynn’s dedication. New medications are very effective at curing the disease, but only if they are taken as directed. Lynn works closely with providers and pharmacies to oversee treatment, which results in more successful outcomes and greatly reduces members’ risk of developing liver failure. “Lynn works with members who are often very ill,” said Anish Patel, Manager, Clinical Pharmacy. “She is always compassionate and understanding. Her work embodies the Fidelis Care Mission.” Lynn serves as a mentor to Staff Pharmacists and Pharmacy Technicians, and is regarded as a knowledgeable and patient teacher. Lynn believes that her
staff has been instrumental in her success. “They are a fantastic team and have such great attention to detail,” she said. “They are always looking out for members’ best interests.” Lynn was hired as Fidelis Care’s first Pharmacy Resident in 2010 before being promoted to Staff Pharmacist a year later and Supervisor, Pharmacist in March 2015. She has watched the Pharmacy Department grow from six employees to about 70 and has been involved in several milestones, such as the Medicaid prescription drug carve-in in 2011. “I am so glad I have been here for the Pharmacy Department’s amazing transformation,” Lynn said. “Erick Moncayo, Assistant Vice President, Pharmacy; Alyssa Im, Director, Pharmacy Services, and Anish have played such a large role in our success. They guide me every day.”
¾ Lynn lives in Secaucus, N.J., with her two sisters. She is based out of Fidelis Care's New York City office.
BOARD OF D I R ECTO R S
Reverend Donald J. Harrington Chairman of the Board
Thomas L. Kelly
Karl Adler, M.D.
Reverend Leo Oâ€™ Donovan
M. William Benedetto
Reverend Monsignor Alan J. Placa (Emeritus)
Sister Patricia Burkard James M. Corrigan Reverend John Coughlin Thomas F. Doodian Reverend Patrick J. Frawley John J. Hurley
E XECUTIVE S TA F F
Reverend Patrick J. Frawley President and Chief Executive Officer David P. Thomas Executive Vice President and Chief Operating Officer Thomas Brown Chief Administrative Officer Thomas Halloran Chief Finance Officer
Donna A. O'Brien
John J. Rydzewski Joseph Slavik Michael J. Tooley Frank J. Thomas, M.D. Mary Thompson John A. Werwaiss
Pamela Hassen Chief Marketing Officer Martin Krebs Chief Information Officer Santo F. Russo Chief Legal Officer Sanjiv Shah, M.D., M.P.H. Chief Medical Officer