Excellus’ Crisis Plan Helps Company Pivot
Working from home, Melissa Gardner, executive vice president, population health engagement at Excellus BCBS, has to juggle work and kids. In a statement, she said: “We are supporting each other more than I would have thought possible,” she said about her colleagues at the insurer. Photo provided.

Excellus’ Crisis Plan Helps Company Pivot

Nearly entire workforce of 3,600 at Excellus still working from home. ‘We haven’t missed a beat,’ says regional president

By Deborah Jeanne Sergeant

Physician Gregory Carnevale,is vice president of medical affairs for retail markets.
Physician Gregory Carnevale,is vice president of medical affairs for retail markets.

Making an organization-wide shift in basic business operations for a company of 3,600 employees represents a huge challenge.

That is why Excellus BlueCross BlueShield has been ready for years to face some sort of major crisis.

Last spring, it turned out to be COVID-19.

Long before the pandemic, about a third of the insurance firm’s employees had been periodically working at home to lessen their need to travel to any of the company’s offices in Syracuse, Watertown, Elmira, Binghamton, Rochester, Utica and Plattsburgh. But it took preparation begun long before the pandemic to shift to a nearly entirely home-based workforce.

The Plan

“Not knowing what the future would bear got us ready for the pandemic,” said Mark Muthumbi, regional president.

Before shifting to an entirely home-based business model, Excellus had in place a means to securely transmit sensitive data and had available sufficient laptops to keep everyone connected. When the governor declared a state of emergency, Excellus was ready. On March 16, the company verified that its systems offered sufficient bandwidth to securely handle all its users working from home. The following day began its work-from-home policy meant to last for the duration of the crisis period.

The Pivot

One would expect snags when making a monumental change such as this; however, Muthumbi said switching to home-based work went very smoothly.

“We haven’t missed a beat,” Muthumbi said. “We’ve been home over the past 10 months. We’ve been meeting and exceeding customer expectations from within the first and second day of the pandemic.”

By March 20, the insurer had launched a COVID-19 web page to address the concerns of members, employers, brokers, providers, media, employees and the general public.

Only about 2% of employees — a few working in the mailroom — still came into the building during the early days of the pandemic. The ability to have the other 98% working from home was a result of imagining that some sort of catastrophe would eventually happen and preparing for that eventuality.

“From our resilience perspective, it’s to make sure we can work from anywhere and have secure connections,” Muthumbi said. “We seem to be doing a good job at that.”

With standard COVID-19 safety precautions in place, a few other employees have begun returning to work because of the open enrollment period, but most are still at home. About 80% of renewals occur in January.

The Problems

Of course, no change of this size comes without its unique challenges. Muthumbi said that for him, it was the change in how Excellus employees interact.

“The traditional setting was the office structure where you can meet with your colleagues,” he said. “Shifting to a virtual environment was one of the challenging parts — seeing them virtually and trying to organize virtually.”

Adjusting to a less regimented day also tested staff’s organization and prioritization skills. At home, without the accustomed cues of passing time, it is easy to work too much or work too little.

“It seems like we have a flow now,” Muthumbi said. “People know when to take breaks and when to finish their day.”

Since employee safety comes first, it’s likely that July will be the very soonest Excellus employees will be back at their offices, depending upon vaccinations, infection rates and other factors.

The Positives

Mark Muthumbi is regional president of Excellus BlueCross BlueShield.
Mark Muthumbi is regional president of Excellus BlueCross BlueShield.

While no one wants a pandemic, it can be helpful to consider some of the growth opportunities that have resulted from COVID-19.

Muthumbi said that Excellus’s “safety net plans” have shown growth as members have left their commercial plans.

Muthumbi has heard from employees that additional time for family activities has proven enjoyable and a means of reducing pandemic stressors. Many employees report that they enjoy working at home.

“We’re in 39 counties and that was a lot of commuting,” Muthumbi said.

The home environment is more relaxed. Through Microsoft Teams meetings, employees may learn more about each other.

“Some of my team’s kids show up,” Muthumbi said. “I know the pets’ names. It makes a more personal relationship than what we had. We’re more open. In our discussions, people are open to seeing each other in their home setting. Those interactions have been positive.”

Excellus has allowed employees to share their stories on the company’s internal website along with tips for maintaining wellbeing, including the employee wellness program.

Reimbursement for telehealth visits

Like other health insurance companies, Excellus covers COVID-19 testing in full for those referred by their physicians and began reimbursing for telehealth. This has allowed healthcare providers to offer access to healthcare while patients quarantined and to continue to reduce foot traffic into the office for more routine issues.

“Providers didn’t really understand how they can reach those patients if they can’t come in,” said physician Gregory Carnevale, vice-president medical affairs for retail markets. “It caught the health industry off guard. It’s in our DNA to prepare for risk. We expanded telemedicine services for not only COVID issues but non-COVID issues. We increased reimbursements to be on par for in-person visits for phone and video visits and waived co-pays and urgent care visits related to COVID.”

This caused an explosion of telemedicine visits.

Excellus also guided healthcare providers through the technical aspects such as coding and billing procedures for telehealth visits.

Internally, Excellus has been working on improving employee wellness. Carnevale referenced the Swiss Cheese Defense Model by Ian M. Mackay, based upon James T. Reason’s Swiss Cheese Model of Accident Causation. As with a stack of Swiss cheese, each layer of COVID-19 defense has “holes.” Each layer of protection is imperfect, yet together they provide adequate coverage. Physical distancing, face masks, hand hygiene, ventilation, contact tracing, disinfection and health screenings and testing are not enough by themselves, but together make a difference.

Pandemic Progress

“Now what we’re trying to focus on is to assist in the many different layers in the equitable and efficient distribution of vaccine,” Carnevale said. “We’re trying to inform our members and employer groups about the availability of vaccines, current segment of the population who’s eligible to receive it and the almost daily information regarding additional possibilities of vaccine to distribute.”

One vaccine, being developed by Johnson & Johnson not yet available will provide protection in just one dose instead of the usual two and will but not require as stringent temperature during storage.

Carnevale also said that Excellus is also concerned about “equity issues in terms of some of our population and some historically racially discrimination. The African American population has a higher rate of non-vaccination and it’s something we have to address because they’re one of the highest groups that has detrimental effects from COVID.”

No one is turned away from receiving the vaccine for reason of cost.

“We’re trying to assist in the distribution process,” Carnevale said. “This is a long-term effort we need to continue to support.”

Excellus BCBS & COVID-19: By the Numbers

• $102 million to pay for increased telemedicine coverage and increased provider reimbursement rates.

• $40 million in cash advances to providers approved beyond normal $192 million in advances.

• $1 million in grants to hospitals for testing supplies and personal protective equipment (PPE).

• $1.5+ million in grants and sponsorships for locally based, health related initiatives.

• $51 million to cover suspension of prior-authorization, reviews, clinical editing programs and claim filing requirements.

• $19-23 million to cover waived copays and member cost sharing for COVID-19 related care.

110,000+ page views on Excellus’s COVID-19 web page.

• $3 million to cover mandated increase in reimbursement for COVID-19 hospital admissions.

• $600,000 in grants to community-based food banks and pantries.

• $30,000 in grants to local diaper banks.

• $17.6 million in medical premium refund credits to employers.

• $3.4 million in dental premium refund credits to employers.

• $200,000+ in grants for “return to work” kits for employers.

• $50,000 in funding for local domestic violence prevention organizations.

• 2 million-plus telemedicine visits, an increase of more than 7,000% from 2019.