More than just a clinic

Imagine a healthcare system where your provider, insurance, and medical services are seamlessly integrated. At Yale Health, this vision has been a reality since 1971, transforming the way nearly 50,000 members of the Yale community access care. More than just a clinic at 55 Lock Street, Yale Health is a pioneering staff-model health maintenance model (HMO) that prioritizes convenience, continuity, and comprehensive care tailored to individual needs.

“Yale Health offers a unique model of care, and it consists of three elements,” says Catherine Kelly, assistant director, Member Services and Health Information Management. “We are a provider of care, a department of Yale University, and an insurance plan.”

Its more than 150 providers — in Dermatology, Ophthalmology, Acute Care, Internal Medicine, Obstetrics & Gynecology, Pediatrics, and more — partner with patients to meet their individual health needs. By housing these services together, Yale Health minimizes the need for members to seek out-of-network care, reducing the potential for additional costs and ensuring continuity of care.

A staff-model HMO

The staff-model HMO is an efficient and comprehensive way to deliver health care and insurance to the Yale community, with nearly 50,000 members across students, faculty, and staff, including their dependents. Almost 80% of faculty and staff choose Yale Health as their health care plan. “Yale was one of the first universities in the U.S. to provide health care services on campus through the staff model HMO,” says Ariel Perez, manager, Member Services and Health Information Management.

This model emphasizes preventive care and coordination of services, starting with the primary care provider (PCP), who acts as the central point of contact for all medical needs. The PCP can order blood work, X-rays and other imaging, prescribe medicines or therapies, and initiate referrals for specialty care. Some specialty services, such as Dermatology and Ophthalmology, are located at 55 Lock Street, whereas others are offsite.

With 90 modern exam rooms; a 15-bed inpatient facility with two negative pressure rooms; a full-service retail pharmacy; and a diagnostic imaging suite that includes MRI, CT scan, x-ray, and ultrasound, “Yale Health is our members’ primary care medical home,” says Kelly. “Many people receive most of their care at 55 Lock Street, which is very convenient; everything you need is in one place.”

Network Partners

“Yale Health is somewhat unique, because not only is it a provider, but for services outside of Lock Street, it is an insurer,” says Referrals Manager Lindsay Rodriguez. “Even though Yale Health is largely a one-stop shop for its members, it is important to understand how the benefit works to avoid unnecessary problems or financial obligations,” adds Rodriguez. Approved referrals are essential for accessing specialty care and are managed by the Referral Department to ensure coverage and appropriate service provision.

For services beyond what is available onsite, Yale Health has established a network that includes Yale Medicine, Yale-New Haven Hospital, and several other institutions. Yale Medicine is the clinical practice of the Yale School of Medicine, with more than 1,700 physicians in more than 155 locations across Connecticut. Yale Health patients may also be referred to care at the Yale-New Haven Hospital (YNHH) York Street campus, the YNHH St. Raphael campus, or the YNHH Shoreline Medical Center in Guilford.

Continuous improvement

Yale Health has implemented processes for improving member experiences by listening to feedback and making necessary adjustments. Patients are encouraged to complete anonymous surveys administered by Press Ganey, an independent third-party company that helps healthcare organizations improve patient experience. After a visit this past summer, a new employee and first-time visitor said, “I was impressed beyond words with the entire experience, including the pharmacy.”

A more seasoned staff member who has been at Yale 12 years said, “Yale Health continues to impress… I feel privileged to have this health care and appreciate the world class effort by everyone.”

Yale Health’s on-site pharmacy and the staff also consistently receive positive reviews, with one patient saying, “The pharmacy staff are great! Have never had a less than satisfactory experience there.”

Patient Representative ShaVonne Harris is an integral part of the improvement process, ensuring that member concerns are addressed and conveyed to appropriate leadership for policy and operational improvements.

Harris acts as a liaison between members and departments, helping to resolve issues and enhancing the overall quality of care. “Whenever I speak to a concerned member,” Harris says, “I respond in a way that imagines how I would want someone to treat my family. This is someone’s mother, or father, or child, and respect goes a long way.”