Phase I of Neighborhood Health Plan of Rhode Island’s Integrated Care Initiative Work Shows Promising Results

  • Neighborhood conducted nearly 40,000 member assessments; has begun coordinating services

  • Helped reduce the number of members living in nursing homes by 11 percent, ER visits by 11 percent and hospitalizations by 6 percent

Smithfield, RI (May 27, 2016) - Neighborhood Health Plan of Rhode Island (Neighborhood), rated one of the top Medicaid health plans in America by NCQA, today released a report highlighting the preliminary results of Phase I of a two-part program to coordinate the benefits for individuals eligible for both Medicare and Medicaid (dual-eligible). Serving nearly 22,000 medically needy and economically vulnerable Rhode Islanders, Neighborhood’s work on the Integrated Care Initiative (ICI) has increased member assessments and better coordinated services while helping decrease the number of members residing in nursing homes, visiting the Emergency Room and staying in the hospital.

The purpose of the ICI is to address the complexity of having benefits and financing split between the Medicare and Medicaid Programs. The ICI coordinates these programs under one cohesive plan. In operation since November 2013, the program is designed as a staged transition, with Phase I addressing only Medicaid services, and Phase II bringing in the full scope of benefits under a single plan. Neighborhood is the only health plan in the state participating in this program.

Phase 1 / UNITY - Neighborhood has established a solid foundation for the program with its UNITY product for the initial phase. UNITY focuses on engagement with Medicaid-only members and wraps holistic services around them regardless of their setting. Neighborhood noted the following encouraging results over the first two years:

  • Conducted over 40,000 assessments
  • Identified key struggles of membership, including housing availability
  • 11% reduction in members residing in nursing home settings; this was despite a 27% increase in the number of members participating in UNITY
  • 6% reduction in hospitalizations
  • 11% reduction in re-hospitalizations

Phase 2 / INTEGRITY – The second phase, expected to begin this summer, will incorporate the full spectrum of services including long term care and medical and hospital services. Neighborhood anticipates that over time this integration will lead to better outcomes for members, as well as controlled and predictable costs for taxpayers.

“Neighborhood is eager to build upon our early investments and results in the Integrated Care Initiative,” said Alison Croke, Vice President for Medicare/Medicaid Integration. “Our managed care model has proven to be very effective over the years and we believe this group of Rhode Islanders will also benefit by working with us.”

About Neighborhood

 

Neighborhood Health Plan of Rhode Island (Neighborhood) is a non-profit HMO that was founded in 1994 to make sure everyone in the state has access to high-quality, affordable health care. Neighborhood has been ranked as one of the top Medicaid health plans in America for the past twelve years and currently serves more than 185,000 members. Neighborhood also recently extended its great service, benefits and value to individuals and businesses through HealthSource RI – the state’s health insurance exchange. For more information visit www.nhpri.org.