Optum: ‘Special Place’ Beset by Maddening Phone Woes, Alleged Doctor Shortages 

While my favorite type of written-word journalism to read is often the straightforward, balanced news report, the format and its rightful traditions sometimes put the squeeze on important truth-telling.

In late July, a respected member of the community, Bedford Corners resident Jennifer Saine, contacted me, asking if we could report on unfolding issues with our local medical group. The organization had recently announced it would now be part of Optum Tri-State, a new entity linking CareMount Medical with ProHEALTH NY and Riverside under the Optum banner.

Journalism is more art than science, and one example of that is how much weight reporters and editors give to an endless stream of reader tips based on who gives them. When someone as thoughtful and level-headed as Saine reaches out, it tells us a lot right out of the gate.

After consulting with Examiner Editor-in-Chief Martin Wilbur, we decided to ask local freelance journalist Sherrie Dulworth to suss out the facts. Sherrie is as thorough a reporter as you can imagine, and we wanted to be extraordinarily comprehensive, citing many patient sources and more, before publishing any piece. Loose talk on social media does not by itself a story make, and we don’t just chase gossipy pap.

But despite Sherrie’s excellent efforts and a little poking around on my end, almost no one wanted to go on the record with their concerns after months of trying.

In vetting and trying to report out a straightforward news article, several patients with stories to tell understandably declined our on-the-record requests, not wanting to complicate relationships with their medical office. While there’s always more poking and prodding you can do, our stab at a straightforward news report or in-depth news feature hit a general dead end by mid-November.

The Name Game

In October of last year, Dr. Scott D. Hayworth, now the CEO and market leader for Optum Tri-State Region, blasted out an e-mail newsletter message announcing his former CareMount organization joining the “Optum family.” (Before it became CareMount in 2016 with a merger of several area practices, the organization was called Mount Kisco Medical Group, known in more recent years as MKMG; the original enterprise was founded in 1946.)

“With gratitude to you and your family for having entrusted your health care to us, I’m proud to share with you that CareMount Medical has joined the Optum family,” Hayworth, a veteran Mount Kisco obstetrician-gynecologist as well, triumphantly declared at the time.

“Optum is a national health services innovation company, helping people live healthier lives and improving the delivery of care for everyone,” continued Hayworth, who also happens to be the husband of former local Republican congresswoman Nan Hayworth. “Partnering with Optum allows us at CareMount to do even more to fulfill our mission to provide you with state-of-the-art care close to home.”

But that promise Hayworth articulated has failed to deliver, scores of patients tell us and tell the wider world on social media. Beyond formal interviews, I’ve also heard story after story from reliable, even-keeled people in personal conversation.

Local Facebook community group pages and social sites like Nextdoor have been littered for months with myriad complaints over deteriorating patient care access and service, particularly around issues with scheduling, health records, and the affiliated patient portal function, along with other infrastructure-type issues. (Even while some patients describe extraordinarily positive experiences and gratitude, which I’ll get to in a minute).

One particularly acute concern has been general headaches over communication – including about the patient portal – and the inability to easily schedule human conversations with doctors. An entire maddening infrastructure of digital and human blockades has been constructed to limit real patient-to-doctor, one-on-one contact. That’s a relatively new development in healthcare requiring a reckoning.

The more you can limit human interaction and increase automation, the more you can scale the business and create a medical delivery system that is somewhat akin to (best-case scenario) a well-run, quality fast-food chain and less like your beloved neighborhood restaurant.

“It’s unbelievable how horrible it is when you need to get ahold of someone,” one commenter stated earlier this week. “I am beyond annoyed as well!!”

When a torrent of new posts started populating local social media groups again this week, I realized it was time to chime in. We didn’t have quite what we needed for a news report. But as a reporting-based opinion columnist, this was a story I felt compelled to tell in some capacity, with more than enough information to tell it.

The frustration of waiting on hold on the phone for ungodly sums of time is a common complaint. (Common enough to be deemed a publishable offense right here in this column after much deliberation and corroboration.) While Optum does have an automatic callback system, locals say that hasn’t fixed the problem.

“They did call me back, but then put me right back on hold,” one commenter said earlier this week. “I finally gave up.”

The new digital portal communication system also receives mixed reviews and tends to be particularly difficult to maneuver for older patients unaccustomed to the technology. Some people told me they were unable to create new accounts in the new Optum portal, or ran into other serious issues in the transition. A patient relayed to me how after they created an account in the new system, all of their medical history, medications, and scheduled appointments were missing.

Phone Woes

To confirm the phone concerns, I tried calling Optum myself multiple times over an extended period of months and discovered similar frustrations. On Friday, I conducted one final experiment, taking more notes along the way.

Mind you, I was feeling entirely healthy, making an aggravating situation much easier to stomach, not to mention the fact that I work from home and don’t have to worry about a boss breathing down my neck while trying to navigate the phone maze. While I felt bad clogging up the line, it felt more irresponsible to not give the phone system another try. (Although I did happen to have a legitimate, if benign, medical question worth asking, which comforted my conscience.)

• I called at 9:30 a.m.
• I waited on hold for about five minutes before hearing the option about getting an automated callback.
• I pressed the automatic callback button by about 9:36 a.m., but it didn’t process.
• I was returned to the computerized operator, which gave me the option of the automatic callback about a full minute later, and I pressed “1” to request a callback.
• As I only later in the afternoon learned, I missed a callback from Optum at 9:52 a.m. because of another time-sensitive call that came in at the same time. I didn’t figure that out until about 2:30 p.m.
• Not realizing I missed the call, I decided to let at least two hours pass before calling again if a call didn’t come unprompted.
• I called again at 11:37 a.m.
• Not until almost five minutes later, at 11:41 a.m., was I offered the option to request an automated callback. I didn’t press the digit “1” quick enough – I think it gave me up to maybe two seconds – and, as a result, I was sent back on hold to continue to listen to excruciatingly irritating hold music.
• Not until two minutes later, at 11:43 a.m., was I provided the option again for an automated callback. I pressed “1.”
• It worked perfectly, generating a callback only two minutes later, at 11:45 a.m. I asked a lovely-sounding receptionist for a doctor to call me, specifying it was a doctor I needed to talk to about an issue, not a nurse or assistant.
• At about 2:30 p.m., after learning about the earlier voicemail, I called again to ask for an ETA on a callback from the doctor. It took another few minutes to reach someone, but a very helpful receptionist, by about 2:35 p.m., explained how the doctor is understandably in with patients and often makes calls after those sessions, if a quick call in between patients isn’t possible. I made it clear it wasn’t urgent. She said the doctor would likely be calling me around or shortly after 4:30 p.m.
• As of print press time, more than three days after my original call, I did not receive the promised phone call from what is more than likely an overworked, over-scheduled and diligent doctor.
• This bullet point is being added after original print and online publication — a very friendly and hospitable assistant (not the doctor) called back on Monday morning, noting she was out and unavailable on Friday.

Patients battling a flawed phone system when ill (or when seeking treatment for a loved one) is no small thing, especially as it sometimes leads frustrated people – in particular busy working people – to abandon or delay care. In fact, it’s a giant problem for any medical establishment genuinely committed to delivering a globally positive experience.

Saine, for her part, stressed how the developments have led to it becoming “difficult to schedule timely appointments, harder to find providers within the group and maintain relationships with those providers because of rushed double-booked seven-minute appointments and being pushed to seeing PAs and nurses.”

Issues with the organization’s billing system are also a lingering, longtime concern, and one I’ve personally heard grumbles about for years and years, well before the Optum development. (One patient told me about charges from 2011 doctor visits they can’t get scrubbed from the system).

“The old CareMount billing department issues have certainly not been resolved, never mind the continual phone problems and long telephone wait times,” added Saine, a trained attorney. “I feel like my family is trapped in a quickly-collapsing system. I have stayed because our doctors are excellent, and we value their expertise, but how long will they even be able to endure being stretched so thin?”

While wanting to avoid sounding melodramatic, Saine pointed out in an interview on Friday how frustration with the phones could have life-threatening consequences.

“It could lead to people not getting diagnosed and not being treated and not getting the care they need to save them,” she said. “That is really what can happen with these things.”

But Saine also explained a bigger picture concern. She worries about Optum’s corporate parent looking to dominate the local market in multiple medical industry buckets – insurance and healthcare. She is right to raise the specter of Optum’s corporate architecture. Here’s the deal:

Optum is a subsidiary of UnitedHealth Group, a Minnesota-headquartered multinational behemoth. The entire enterprise appears to be inherently problematic, as the broader organization is both a healthcare and insurance company, even if the two areas are allegedly siloed. What could possibly go wrong?

The answer is plenty, for those keeping score at home.

Poor ‘Judge’ment

In fact, just last month, the illustrious and Pulitzer Prize-winning investigative journalism site, ProPublica, published an explosive report outlining how UnitedHealth might use a treasure trove of patient data to give itself a competitive edge.

A federal judge had permitted the company to acquire a mind-boggling boatload of health insurance claims. While UnitedHealth publicly insists it won’t use the data to benefit itself – just trust us. Ha! – some company documents indicate otherwise, ProPublica reported.

Meanwhile, after the ProPublica piece published, the U.S. Justice Department (as well as the New York and Minnesota attorneys general) filed a Nov. 18 notice stating they will appeal a decision by Judge Carl Nichols that allows UnitedHealth Group to acquire a company called Change Healthcare. (It was former President Donald Trump who nominated Nichols for the federal judgeship; the judge was commissioned onto the United States District Court for the District of Columbia in 2019.)

Regarding Change Healthcare, it is a firm that connects medical patients, payers, and providers. As ProPublica described it, the company “functions as the pipes that carry insurance claims between health care providers and insurers.”

Yeah, again, what could go wrong?

Good Guys, Bad Outcome 

It’s worth emphasizing how Hayworth and his top colleagues might very well be pleasant folks. I don’t mean that facetiously. Hayworth is known locally for seriously impactful philanthropy and is surely a fine doctor, committed to the Hippocratic oath and all the rest. I have friends who speak glowingly of him as a doctor from personal experience, even while critics have harsher conclusions to share about his business practices. But Hayworth the man is not the point, even if he’s the local man best positioned to address the point.

The point is we have a fundamentally flawed system leading to the problems that drive people batty, sending your friends and neighbors (including some of the reasonable, even-tempered ones) to vent on social media, with little or no other recourse.

A consolidated local medical industry motivated almost exclusively by profit can much more than justify fewer human beings answering the phone, even if it negatively impacts the patient experience, as long as the near-monopolistic dominance is potent enough to avoid losing too many paying “customers” while limiting business expenses. (Optum does have competitors, and some patients say they are fleeing to alternatives, even if it means a little extra travel.)

As a doctor might conclude in a complicated case, I can diagnose what’s triggering the symptoms but not provide a cure-all treatment.

That said, the Justice Department appeal of the judge’s seemingly wrongheaded decision (please read that ProPublica article) appears to be one place to start. (Not to mention Optum deciding to invest a few lousy bucks on more people to answer the damn phones and general customer experience enhancements; even if doing so requires, ahem, modestly trimming executive pay; although it feels safe to suspect there’s some surplus dollars lying around to pay more personnel and keep the talented execs fully and handsomely compensated.)

Middle Ground

Everything doesn’t have to be a far-left versus far-right ideological screaming match either, debating fully socialized medicine on one extreme versus an almost entirely unrestrained medical industry on the other. A layman can see the dangers in the consolidation of private medical power into too few hands and still enthusiastically embrace the beauties of capitalism to generate elite medical innovation.

That all said, we were very eager to hear Optum’s point of view about patient experience. We spent weeks trying to secure an interview, offering in-person, video, or phone options. Eventually, all we were granted was a canned statement over e-mail.

“Our priority is to keep our valued patients informed during our transition to Optum – and share what this means for them,” stated a ridiculous filibustering reply to what we were trying to ascertain for our readers, aka many of Optum’s patients. “Our three medical groups have the expertise, experience and dedication to create exceptional, personalized experiences for our patients, their families and our communities.”

While not an exact quotation, the next 116 words of the statement, essentially all bureaucratic corporate communications speak, basically read “blah, blah, blah,” and was signed by Hayworth and Kevin Conroy, the president of Optum in the tri-state region, which boasts how it provides “access to more than 2,100 providers, representing 70 specialties, working in 360 medical practices and more than 55 urgent care locations across New York, New Jersey, and Southern Connecticut.”

We also reached out yet again just before publishing this column, offering Optum a post-publication interview opportunity to address patient concerns in a follow-up news article. Fingers crossed.

FYI

In the name of transparency, it’s important for readers to know that medical institutions are relatively significant advertisers for local news outlets, and we’re no exception.

CareMount et al. has been a major client of ours over the past 15 years. Community news outlets are not financially incentivized to publish hard-hitting area health institution coverage, even as many do exactly that to the best of their abilities.

Setting all of that aside, if Optum’s corporate communications department is reading this now, we’d still love the opportunity to ask follow-up questions – about doctor buyouts, compensation for executives, whether some money could be better spent on fuller medical staffing levels and a variety of other questions. Given the overlap between our coverage area — from White Plains to Northern Westchester and up through Putnam County — and Optum’s market reach for prospective patients, it feels like a meaningful opportunity to share Optum’s perspective with its frustrated constituency.

What’s important to stress is how no reasonable observer doubts that Optum is populated by wonderful doctors and support staff, while very many patients undoubtedly enjoy sterling treatment, sometimes in the lifesaving variety. Much of the care is genuinely world-class, delivered by elite medical talent, and the community is extraordinarily lucky in that regard. In fact, my interview with Mount Kisco resident Donna Cravotta (full disclosure: she’s a friend and former colleague) illustrates that very fact.

Cravotta and her young adult son, Matt, have been patients for about 15 years. While she notes how “making appointments is horrendous,” she also emphasized how she does not “think the Optum-bashing is fair” and how “as a middle-aged woman who lives alone with health issues, I am grateful to have quality healthcare all around me.”

“I know the scheduling problem can be resolved,” Cravotta said. “In the past six months, I’ve been seeing two new doctors, a primary care physician and an electrophysiologist, who both handle the scheduling. When I visited my primary doctor, I made an appointment for next year as I was leaving. The electrophysiologist’s office is incredible at handling scheduling and insurance issues. The entire organization should follow their lead.”

Cravotta, like many patients, sees the good and the bad. For instance, on the negative side, there was a preposterous 18-month wait to get an annual appointment with her gynecologist. She ended up seeing a nurse practitioner at the Yorktown office and made an appointment with her doctor for 2023. While the nurse practitioner was “very thorough,” Cravotta also noted how it is “not a good solution.”

On the flip side, other than an issue she had with two cardiologists in the past, she said she has “loved all of our doctors through the years” and also remarked how she likes how all of her medical records and doctors are in one centralized location.

“And…the offices are convenient,” she added. “Matt is going to college in New Paltz. There is an Optum office five minutes away. I have also visited the Yorktown office, Katonah office, the Briarcliff office, and urgent care; all are very convenient.”

‘Totally Fixable’ 

But the bigger, related issue appears to be what some say is a doctor shortage at the medical group as a result of intentional, profit-driven attrition.

Maybe there’s no shortage at all. That’s where, Optum, you can chime in and alert our readers to whether their perception is your company’s reality – or not. And, if it’s not, how you might explain and/or address the widespread community sentiment about diminished service.

“Not only do you wait a year or two for appointments, but once there, the appointments are three minutes, and they have one (expletive) foot out the door to get to the next of their 300 patients scheduled for the day,” one infuriated patient told me, requesting anonymity to speak freely about their current healthcare provider. “What has happened to me on many occasions is one waits on hold for hours and then someone picks up and disconnects you.”

But to Cravotta, a self-employed marketing strategist, the understandable outrage expressed by patients like the unnamed source illustrate a frustrating dynamic. Cravotta moved to town in part because there was an impressive medical group nearby, along with Northern Westchester Hospital. To have such specialized medical care in a small suburban community is a genuine blessing, she said, and, in her view, the problems at Optum are “totally fixable.”

The company should hire a user experience (UX) consultant so Optum can better interact with patients and use that feedback to improve the organization, Cravotta stressed. If, say, the portal was enhanced with a finer eye toward user experience, and molded into a super easy-to-use, one-stop-shop, more time would be opened up to deal with incoming issues and concerns, over the phone and otherwise. A “UX” expert could examine processes and procedures across the organization for low-hanging fruit to pick at and improve.

“How lucky are we to live in this town and have this level of care?” Cravotta said in a phone interview Friday afternoon. “So much of this conversation is because you can’t make an appointment. But it’s amazing we live in a town where you can go see a cardiologist, an internist, a hand specialist, whatever you need. This very fixable issue is detracting from a very special place.”

Another source explained how their family has physicians at Westchester Medical, Columbia Physicians, and Phelps, and they have all successfully incorporated technology to enhance administrative efficiencies for patients. So it’s not like all medical organizations have failed to figure it out.

“Phelps, in particular, has a great Zoom like setup for remote consults when an in-office visit is not possible,” the source noted. “Phelps makes excellent use of technology to make things more accessible and not a barrier to care. Phelps also sends out a questionnaire after every interaction to make sure things went well and to address any patient dissatisfaction — they really try hard to get it right. The solutions are out there.”

As for any of you doctors out there reading this column, we don’t usually grant off-the-record interviews. This is a case where we’d make an exception. (Some casual preliminary conversations indicate that patient frustration with Optum is shared by some staff).

You know how to find us.

One way or the other, these first few pages of Optum Tri-State’s local history are just the beginning of an important story we’ll all continue to live through together and tell.

Please stay tuned and be in touch.