Peter M. Marino: Better Care for Poor, Vulnerable in R.I.

As published in The Providence Journal, Monday, May 16, 2016

Recently, Gov. Gina Raimondo wrote about “Expanding access to health care” (Commentary, April 3) and how the administration’s efforts to “Reinvent Medicaid” are bending the cost curve and improving quality of care. She and her team are to be applauded for their forward thinking and their drive to ensure that Rhode Island’s Medicaid program remains effective and sustainable.

Family With DoctorWhat the Raimondo administration is also doing is preparing to move the last — and most complex and costly — groups of Medicaid participants into proven managed care programs.

Managed care organizations (MCOs) have been leaders in reform, serving Rhode Island communities and driving innovation in health care for more than 23 years. In partnership with the state, Rhode Island’s managed care program is one of the most successful in the nation and has been lauded for achieving remarkable results:

  • We now annually provide health coverage to more than 250,000 people who are low-income.
  • Rhode Island ranked No. 1 in children's Medicaid health-care quality in 2015, according to the Centers for Medicare and Medicaid Services.
  • Each of the contracted health plans has consistently ranked among the top 10 in the nation according to the National Committee for Quality Assurance.
  • Costs for populations in managed care have been controlled and predictable.

And, the majority of this work has been done by Neighborhood Health Plan of Rhode Island, a local, nonprofit company that employs nearly 450 people and has an administrative rate about half that of the large commercial health insurers.

We achieve these results by putting members first and working with our provider partners to make sure the patient’s specific needs are met. We encourage our members to obtain care through our community health center partners, which are recognized by the National Committee for Quality Assurance as Patient Centered Medical Homes and offer many services, including behavioral and oral health. Internally, our dedicated staff are relentless advocates for our members who help them navigate the medical system and address critical social needs like food, clothing and housing, and deliver these services at a price taxpayers can afford.

As new populations move into managed care, we make an initial investment in services and supports, which results in increasingly stable costs over time. For example, eight years ago, the state moved many adults with disabilities into Medicaid managed care through a program called Rhody Health Partners (RHP). Since that time, enrollment in RHP has continued to climb, while Neighborhood’s costs per member per month have stabilized (0.4 percent average growth, 2012 through 2014). Other populations we serve — children in substitute care (down 1.7 percent) and children and families (down 2.5 percent) — experienced similar results from 2012 through 2014.

Soon, in partnership with Neighborhood Health Plan of Rhode Island and the Centers for Medicare and Medicaid Services, the state will bring full managed care to one group that needs it the most: people eligible for both Medicaid and Medicare. Known as Phase II of the Integrated Care Initiative, financially vulnerable and medically at-risk participants will have their benefits streamlined under Neighborhood and will be granted access to the same model of care as other populations. With this aligned financing and focused care, we can help coordinate and improve the full suite of benefits, including primary care, hospital care, behavioral health and long-term services and supports.

Rhode Island has long been a leader in creating and implementing Medicaid reforms that improve access to care and deliver high-quality services while controlling the corresponding costs. We have the most successful Medicaid managed care program in the country and the state will soon offer it to our most complex and costly Medicaid participants. As we look to create the next generation Medicaid program in our state, building upon the proven managed care model delivered by Neighborhood is a good place to start.

Peter M. Marino is president and chief executive officer of Neighborhood Health Plan of Rhode Island.