CDPHP

Established in 1984, CDPHP is a physician-founded, member-focused and community-based not-for-profit health plan that offers high-quality affordable health insurance plans to members in 29 counties throughout New York.

Hospital Experience Program

Through CDPHP Hospital Experience Program, admitted patients benefit from a coordinated care team that helps ensure full understanding of insurance coverage, expedites authorization decisions, and prepares patients to transition home. How does this build trustworthiness? Helping patients navigate a complicated care system at a time of great vulnerability improves feelings of safety and security, building trust in the health plan as a partner in access to care.

How It Works

The CDPHP Hospital Experience Program works to enhance the patient experience for CDPHP members who are admitted to the hospital. The goal is to make the appropriate resources available to members when they need it most. CDPHP has partnered with the three of the largest hospitals in New York’s Capital Region (Albany Medical Center, St. Peter’s Health Partners, and Ellis Medicine) to redesign how our members progress through the continuum of care while both in the hospital and after discharge.

CDPHP also prepares members for transition from hospital to home. For members at high-risk for readmission, the plan offers an in-home visit within three days of discharge to check on the member, reinforce discharge plan instructions, complete medication reconciliation, assure follow-up appointments are scheduled, and remove any barriers to care. The member is also considered for the plan’s case management services. For members at moderate and low risk for readmission, CDPHP has telephonic programs to conduct similar assessments.

Skills and Competencies

The CDPHP Care Team consists of Medical Directors, Pharmacists, Inpatient Care Coordinators, Medical and Behavioral Health Case Managers, and Healthcare Advocates. The plan deployed the multi-faceted team within the hospital to make sure members’ needs are met, and ensure the health plan is part of the hospital utilization solution, and not a barrier.

The CDPHP Care Team visits with each member upon admission to introduce themselves, their role, and how to get in touch with the team while hospitalized. The team then completes an assessment of what brought the member to the hospital. The assessment includes evaluating the member’s relationship with a primary care physician, history of chronic conditions, compliance with an established plan of care, support systems, and any social determinants of health that may be impacting their health (i.e. lack of transportation, access to healthy food).

CDPHP Medical Directors round with our staff three days per week to evaluate the needs of the most complex members. Authorization decisions can be made on the spot, education of CDPHP programs to support the members’ health care needs are introduced, and assistance in breaking down any barriers to the next step in care takes place. Through daily interaction with members, CDPHP serves to support the hospital’s treating physician by reinforcing health care education, identifying gaps in care that can be addressed while at the hospital or upon discharge, and getting people engaged with the many supportive programs CDPHP offers free of charge.

Origins

Health care is confusing, concerning, and costly. What’s more, understanding your insurance plan weighs heavily on members when they are hospitalized. The CDPHP Hospital Experience Programs was designed to take that weight off the patient. The CDPHP Care Team works with the patient, their family, and any other support systems in place to ensure the member feels safe and secure, while ensuring they have access to highest-quality of care.

Effectiveness

Yes, in the quarter immediately following the launch of the hospital experience program, patient satisfaction scores at Ellis hospital rose 11.4%.

Scalability

The CDPHP Hospital Experience Program was initially piloted in Ellis Hospital in Schenectady, NY. Early spikes in patient satisfaction scores prompted to the plan to expand the program to St. Peter’s Health Partner Hospital. The health plan expanded the program to Albany Medical Center in April 2021.