Talya Schwartz always knew she was going to be a medical doctor. For her this was a calling she could not resist, and from the age of 5, young Talya proclaimed her dream at every stage in her schooling until she graduated from Sackler Medical School in Tel Aviv. She had no medical mentors in her family, but her medical passion was fueled by her love for children and her deep desire to care for others.
Talya pursued her dream and followed her passion, resulting in a colorful tapestry of accomplishments. After medical school, she went on to do her internship at Maimonides Medical Center, was a fellow at the Children’s National Hospital and a research fellow at the National Institute of Health. She also did post graduate studies at the University of Pennsylvania.
Today, the decorated pediatrician is at the helm of one of the country’s top 500 corporations generating annual revenues in excess of $3 billion. Dr. Talya Schwartz is the president and CEO for MetroPlus Health Plan and she is driven by the organization’s core mandate to ensure proper trouble-free access to health care for all MetroPlus members and to ensure that New York’s most vulnerable population has the health care they need.
MetroPlus, which is a wholly-owned subsidiary of New York City Health+Hospital Corporation, has been going strong for 30 years, with almost 600,000 members, 35,000 providers, some 6,000 personal care physicians and thousands of dentists. Schwartz guides the health plan with a solid commitment to maintain the highest quality of care with laser beam focus on what’s important in the continued support of its members and how to make sure that they are covered during these difficult times of the coronavirus.
“Much of our population suffers with health challenges, service disparities, and lack of resources. We want to make sure that they maintain their best health, especially when certain things are not affordable to them,” Dr. Schwartz expressed.
This medical executive has masterfully amalgamated her commitment to human service, her extensive medical background and her corporate acumen to thrust this institution ahead as a transformative leader during this COVID-19 pandemic. It was in May of 2019 that Schwartz took the reign as head of MetroPlus. She previously served three years as the organization’s Chief Medical Officer. Now she is ramping things up to better serve members and to better train and equip the health plan’s 1,200 employees.
Despite COVID-19, the organization has continued to operate without a hitch – maintaining its central operations and all essential functions. “We worked to ensure that all of our members have access to their doctors, we maintained payment flow to providers so they would stay afloat and we ensured that all members have continuity of care,” she contends. According to Schwartz, the highest quality of health care is at the core of MetroPlus’s core values.
It is for this reason that she and her team are motivated each day to make life better, health care safer, and providers nearer to all their members. MetroPlus’s direct alliance with the city puts the organization in direct link to a host of social service agencies that are run by the city. Beyond health care, MetroPlus actively assists its members in accessing a wide range of other city services including housing, family services and food security. Since the Spring, the organization has distributed more than 10,000 boxes of food to families in need.
COVID-19 has also helped to motivate the ramping up of the health plan’s telemedicine agenda. Under Schwartz’s leadership, MetroPlus has aggressively stepped up the adoption of this growing phenomenon, and since rolling out its telehealth program, some 200,000 members have been served. So effective is the company’s telehealth program, MetroPlus was recently honored for its leadership and exceptional activation and acceleration of telehealth services to members in response to COVID. It was late March that the company initially launched this program to ensure that its members had access to medical professionals while maintaining social distancing, and according to Amwell Medical, the organization that issued the award, MetroPlus has shown exceptional resilience as a leading provider of vital 24/7 telehealth services to its members.
Beyond telemedicine, MetroPlus is well postured to expand its membership among New York City’s 8 million people as it strengthens its alliance with peers, providers, personnel, and patients. Schwartz is solid in her conviction that it must be quality over quantity and people over profit. “If there is joint communication and a data flow among the key stakeholders in a patient’s care, we will be better aligned and can more effectively deliver eloquent care, efficient service and excellent coverage,” she affirmed.
Dr. Talya Schwartz is bold in her declaration that success will follow this quality of service, and as she continues to mold the varied departments with a different focus, she is steadfast in her belief that by developing teams and working with her case managers, talent management, compliance, learning and development, and all the other departments, the company will continue to grow stronger and its impact will continue to be felt.
For Medicaid, Essential Plan (EP), Subsidized Child Health Plus (CHP) coverages, disenrollment on the basis of needing to perform annual recertification has been halted through the end of September and eligibility is being extended for affected individuals at least through March 2021. Disenrollment based on other factors, like moving out of NYS or upon request, is still occurring. Special Enrollment Period for QHP, allowing individuals to sign up for insurance outside the normal window, has been extended through September 15, 2021. For Managed Long Term Care, disenrollment on the basis of not accessing services, like homecare or adult day care, has been halted to address concerns about safety during the crisis.
Federal law requires health plans to cover medically necessary testing for covid-19 and prohibits charging of co-pays, co-insurance, or deductibles for testing related to COVID-19. This includes doctors’ visits and lab services. NYS regulation also requires that insurers do not perform otherwise standard utilization reviews for in-patient hospitals stays for the treatment of COVID-19, through at least September 9, 2020.