Rhode Island Earns Federal Support for Innovative New Program to Improve Care for Elders and Adults with Disabilities

Published on Thursday, April 28, 2016

Innovative new partnership with Neighborhood Health Plan of Rhode Islandwill manage care for more than 10,000 Rhode Islanders

CRANSTON, R.I. –The Rhode Island Executive Office of Health and Human Services (EOHHS) in partnership with the federal Centers for Medicare & Medicaid Services (CMS) and Neighborhood Health Plan of Rhode Island (Neighborhood) today announced the agencies have signed a three-way contract that paves the way towards launching an innovative healthcare initiative for some of the state’s most vulnerable residents. This new program,which is the second phase of the EOHHS Integrated Care Initiative, will improve services and help control costs for the 10,000 to 14,000 people who are expected to enroll.

“Rhode Island continues to play a leading role nationally in building healthier communities and sparking innovation across our healthcare system,” said Governor Gina M. Raimondo. “Through this new initiative, we are improving access to high-quality care and creating a system that is more efficient, coordinated, and responsive to Rhode Islanders’ needs.”

In the first phase of the Integrated Care Initiative, EOHHS established a new Medicaid managed care program called Rhody Health Options, which allows beneficiaries who have both Medicare and Medicaid, as well as Medicaid beneficiaries who are receiving long-term care services, to enroll in Neighborhood to coordinate their Medicaid services. The second phase of the Integrated Care Initiative creates a new Neighborhood Medicare-Medicaid plan to provide an integrated set of benefits for enrollees, based on the goal of person-centered care.

Only 12 other states have been approved by CMS to offer similarly integrated models for the dual-eligible population.

EOHHS estimates that approximately 30,000 Rhode Islanders are eligible for both Medicaid and Medicare.Dual-eligible Rhode Islanders are typically older individuals or adults with disabilities who have a wide range of healthcare needs and who are often economically disadvantaged. They also receive their health coverage through two separate programs, Medicare and Medicaid, which typically are operated separately, offer different benefits, and have different rules for providers and their beneficiaries. As a result, the care of dual-eligibles is often fragmented and expensive. Rhode Island’s Integrated Care Initiative was created to address this problem.

In line with the goals outlined in Rhode Island’s Reinventing Medicaid and healthcare innovation initiatives, Neighborhood will focus on dual-eligibles in an effort to improve their health outcomes, at a lower cost. Through the integration of Medicare and Medicaid benefits, the new Medicare-Medicaid plan will make it easier for members to get the care they need. Each member will have access to a care coordinator to help them manage the full scope of their healthcare and social needs including primary care, hospital care, behavioral health, long-term services and supports, and social services.

"Neighborhood has a long and successful record of working with the state, the community health centers and others to improve member access to high-quality services at a price taxpayers can afford," said Peter M. Marino, President and Chief Executive Officer for Neighborhood Health Plan of Rhode Island. "This new work to integrate Medicaid and Medicare benefits and help some of Rhode Island's most vulnerable people represents our biggest opportunity to date. We believe we will be able to make a major difference by getting these new members the right care at the right time and controlling the corresponding costs."

“Since the beginning of Medicaid managed care more than 20 years ago, Neighborhood has been a strong and consistent partner in the State’s work to control costs and improve care for people in managed care programs,” said Health and Human Services Secretary Elizabeth Roberts. “We look forward to continuing to collaborate with Neighborhood and the federal government on this innovative new initiative, which will strengthen the quality of care provided to some of our most vulnerable neighbors.”

The signing of the three-way contract by EOHHS, CMS, and Neighborhood will provide dual-eligible individuals with the opportunity to join Neighborhood’s offering, called INTEGRITY, beginning Summer 2016.

“This initiative should help deliver better quality and more cost-effective care to some of our most vulnerable citizens,” said U.S. Senator Jack Reed.

“I applaud the state and Neighborhood for taking steps to improve care coordination and support better health outcomes for Rhode Islanders enrolled in both Medicare and Medicaid,” said Senator Sheldon Whitehouse. “By integrating the benefits of these two programs, it will be easier for our most vulnerable residents to access the care they need.This is just the kind of win-win healthcare reform I've been fighting to support in Congress.”

“Navigating the health insurance and healthcare industries can be a daunting challenge, especially when an individual has significant healthcare needs,” said Congressman Jim Langevin. “This initiative will simplify and streamline the process for Rhode Islanders, and the elderly and disabled, in particular, and will shift toward a coordinated care system that reduces duplicative services, reins in costs,and improves patient outcomes.”

“Ensuring everyone in this country has access to high-quality, affordable healthcare is one of our most important responsibilities, which is why I am glad Rhode Island is leading the way in developing an innovative program to integrate Medicaid and Medicare offerings,” said Congressman David N. Cicilline. “This initiative will improve the efficiency of our healthcare system and ensure that those who rely on these programs for care can access the services they need at a cost within reach. I thank Governor Raimondo and state leaders for their leadership on this issue to ensure better healthcare for all Rhode Islanders.”

Federal authority for Phase IIof the Integrated Care Initiative is through the Centers for Medicare &Medicaid Services’(CMS) Financial Alignment Initiative, a federal demonstration to better align the financing of Medicare and Medicaid and integrate primary, acute, behavioral health, and long-term services and supports for Medicare-Medicaid enrollees.

CMS, EOHHS and Neighborhood have established quality metricsto measure and ensure the success of the initiative. CMS has also contracted with an independent evaluator to analyze the impact of the Integrated Care Initiative demonstration, as well as the Financial Alignment Initiative overall.

MEDIA CONTACTS:

Sophie O’Connell (EOHHS)

401-462-0854(o)

401-275-3837 (c)

Sophie.OConnell@ohhs.ri.gov

Tom Boucher (Neighborhood)

401-459-6016

tboucher@nhpri.org