Continues integrated benefits for Rhode Island’s most medically-fragile and
October 29, 2020 (Smithfield, RI) – Neighborhood Health Plan of Rhode Island (Neighborhood) today announced it signed a three-year extension with the federal Centers for Medicare & Medicaid Services (CMS) and the Rhode Island Executive Office of Health and Human Services (EOHHS) to continue its Medicare-Medicaid Duals Program. The contract extension ensures that the more than 13,000 members on Neighborhood’s INTEGRITY (Medicare-Medicaid Plan) plan will have uninterrupted access to integrated managed care services through 2023. The renewal follows Neighborhood’s naming by CMS as a top scoring Medicare-Medicaid Plan for “Overall Rating of Health Plan” as a result of the 2019 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. It also comes on the heels of a strong performance by Neighborhood on key outcome measures established prior to the 2016 launch of INTEGRITY.
“When Neighborhood began working with the state to integrate Medicaid and Medicare benefits, we knew we had an opportunity to help some of Rhode Island’s most vulnerable residents by streamlining their access to high-quality health care and creating long-term stability for them,” said Peter Marino, president and CEO of Neighborhood. “We are proud of the work we have done with EOHHS, CMS and terrific providers in the community to build a nationally-recognized Medicare-Medicaid program that provides first-class care coordination for eligible members and are honored to continue such important work.”
Through Neighborhood’s INTEGRITY plan, members – dual-eligible Rhode Islanders – receive 24/7 care management, access to housing and rehabilitation specialists, long term services and supports (LTSS), and other flexible benefits like home maker services, a personal emergency response system, and meal delivery. Dual-eligible Rhode Islanders are typically older individuals or adults with disabilities who have a wide range of health care needs and who are often economically-disadvantaged.
Key benefits of Neighborhood’s INTEGRITY plan include coordinated care teams, a person-centered approach to care, no plan co-pays, premiums or deductibles; and one health insurance card that covers both Medicare and Medicaid services. Additionally, members have access to a care manager to help navigate the complexity of the system as well as maintain good health.
Marino added, “Neighborhood wanted to be instrumental in transforming care for dual eligible Rhode Islanders and knew we had the experience and qualifications to do so. We were founded 25 years ago by the state’s community health centers to provide high-quality health care to the most at-risk people in Rhode Island. Since then, Neighborhood has become a top national health plan and has received “Excellent” ratings from the National Committee for Quality Assurance for 19 consecutive years. As one of nine Medicare-Medicaid demonstration plans in the country, we have invested significant resources to create the operational and clinical infrastructure needed. The impact of these efforts is evident in our plan’s performance on key outcome measures for our dually-eligible members. We are excited to partner with our state and federal colleagues to continue to improve care.”
As part of the April 2016 launch of Rhode Island’s Medicare-Medicaid Plan, CMS, EOHHS and Neighborhood established clinical quality and member experience metrics to measure the success of the initiative. The 2019 results of the Healthcare Effectiveness Data and Information Set (HEDIS) measures for INTEGRITY, covering performance during the 2018 calendar year, illustrate that Neighborhood performed better than the national Medicare-Medicaid Plan average on 37 out of 46 measures (80.4%). Specific strengths on performance measures included Prevention and Screening, Respiratory Conditions, Cardiovascular Conditions, and Behavioral Health, where 100% of measures scored above the Medicare-Medicaid Plan national average. Marino attributes these outcomes to the “incredible collaboration between Neighborhood’s strong provider network and our care management teams.”
Neighborhood is the only health insurer in Rhode Island offering a Medicare-Medicaid Plan. Neighborhood’s extended contract continues the existing agreement with a change related to the quality withhold payment.
Neighborhood Health Plan of Rhode Island is a not-for-profit health insurance plan. We currently serve about 200,000 members in the state. Nearly 80 percent of our membership is Medicaid eligible through our ACCESS and TRUST plans while 7 percent of our members utilize our INTEGRITY Medicare-Medicaid Plan (MMP). About 14 percent of our membership represents individuals, families and small businesses who select one of eight Neighborhood commercial plans available through the health exchange, HealthSource RI. Of these members, about 85 percent qualify for federal subsidies to cover a portion of their costs.
In December 1993, Neighborhood was founded in partnership with Rhode Island’s Community Health Centers. We served our first 1,490 members in December 1994, and by 2000, we grew to 50,000 members. Starting in November 2013, Neighborhood doubled its membership, revenue, and staff through the introduction of the Affordable Care Act and state leadership’s decision to extend coverage to more Rhode Islanders.
In December 2019, we celebrated 25 years of service. Since 2001 – for 19 consecutive years – the National Committee for Quality Assurance (NCQA) has rated Neighborhood one of the top Medicaid health plans in America. Since 2014, our commercial plans have earned NCQA’s highest accreditation level. Today, Neighborhood – with 500 employees and
$1.4 billion in revenue – serves one out of every five Rhode Islanders.
Learn more at nhpri.org