Neighborhood’s work to buttress the state’s long-term care continuum helps hundreds of RI residents eligible for Medicaid and Medicare avoid long-term care stays
March 20, 2017 (Smithfield) – An analysis of almost three years’ worth of state and internal data shows close to 500 Rhode Islanders avoided an unnecessary long-term admission to a nursing home and almost 150 Rhode Islanders were successfully transitioned out of such placements thanks to Neighborhood Health Plan of Rhode Island’s work in support of the state’s Integrated Care Initiative (ICI), the not-for-profit health insurer announced today. The ICI is part of state efforts to rebalance the long-term care system, helping more people live in the community with appropriate supports, rather than be placed in a skilled nursing facility.
Since 2013, Neighborhood’s teams diverted 495 Rhode Islanders from long-term placements in skilled nursing facilities, helping them instead to obtain and maintain independent living arrangements with the necessary supports and services. With the cost of nursing home care averaging $3000/month, each diversion potentially saves taxpayers $36,000/year – for a total savings of close to $18 million.
The 495 Rhode Islanders cited here are Neighborhood members who were initially sent to nursing facilities for short-term placements. Neighborhood’s care management teams partner with those facilities and play an active role in the members’ discharge planning, working to determine if a member is in fact able to live independently in the community. When members fit those criteria, Neighborhood connects them with the appropriate supports and services, facilitating their transitions back home – and diverting them from long-term stays at nursing homes.
“People who are older or disabled are often eager to remain in their homes and communities for as long as possible, and Neighborhood Health Plan of Rhode Island helps make that happen through our managed care programs,” said Peter Marino, Neighborhood’s President and CEO. “We know that Rhode Island’s seniors have the potential to be more physically and emotionally well when they are able to live independently. We also know that helping them do so can provide substantial cost savings to our state’s taxpayers.”
Neighborhood partnered with the state to launch the two-phase ICI in November 2013, targeting people dually-eligible for Medicare and Medicaid benefits. Neighborhood’s role in Phase I covered individuals’ Medicaid benefits; Phase II, which required a partnership with the federal government as well, covers members’ Medicaid and Medicare benefits and began enrolling its first members in July 2016.
“These numbers are particularly impressive when you take into account that we only started working with the dual-eligible population eight months ago,” added Marino. “We can expect cost savings to increase and health outcomes to improve on an even greater scale as we expand our operations.”
Neighborhood has also had success transitioning its Medicaid members who are already living in nursing homes back to home/community settings. From 2014 – 2016 Neighborhood transitioned 147 Rhode Island residents, helping them move from a nursing facility and into independent living with community-based services.
“Neighborhood understands that in many cases, skilled nursing facilities can be the most appropriate places for our members to live. But a substantial segment of the population is able to live independently with the supports that we can help to provide,” said Alison Croke, Neighborhood’s Vice President of Medicare/Medicaid Integration. “Those supports might come in the form of access to Neighborhood’s team of community health workers, a connection to an Adult Day health care facility, the availability of respite support for a primary caregiver, or any one of a number of other options.”
“Building and supporting a long-term care continuum requires a significant investment of time and resources, and Neighborhood is proud being part of this effort,” said CEO Pete Marino. “Neighborhood has decades of experience advocating for at-risk Rhode Islanders, and the ICI builds on our achievements. Neighborhood’s work with the state’s RIte care populations is a great example; our RIte Care plan has been nationally recognized for high-quality and has been praised by state leaders for its commitment to quality and to cost efficiencies. We anticipate the same levels of success as the ICI grows in the coming years.”
Neighborhood Health Plan of Rhode Island is a non-profit HMO that was founded in 1993 in partnership with Rhode Island’s Community Health Centers. Currently serving more than 190,000 members, Neighborhood has doubled in membership, revenue and staff since November 2013 as a result of the Affordable Care Act and decisions state leaders have made to extend coverage to more Rhode Islanders. Neighborhood has also extended its service, benefits and value to individuals and businesses through HealthSource RI – the state’s health insurance exchange; Neighborhood serves 52% of the RI exchange market. Neighborhood has been rated by National Committee for Quality Assurance (NCQA) as one of the top Medicaid health plans in America every single year since ratings began – one of only two organizations in the country to have this distinction