Rhode Island has been given the green light for a pilot program to coordinate health care for people enrolled in both Medicare and Medicaid. They're known as “dual eligibles” and have to navigate two complex systems to get the care they need.

Kristin Gourlay / RIPR

Governor Gina Raimondo has asked a working group to come up with a way to slow health care spending in Rhode Island. It's a strategy that has showed promise in Massachusetts.

Raimondo signed an executive order to establish the Working Group for Health Care Innovation. The group’s charge is to propose a way to limit the growth in public and private health care spending. One model might be close to home. Raimondo says Massachusetts placed a cap on spending.

Kristin Gourlay / RIPR

Medicare has proposed a new rule that would allow doctors to bill for end-of-life conversations with patients. It’s part of Care New England nurse practitioner Terry Rochon’s job to have these sometimes lengthy, delicate discussions with patients, to document the kind of care they want as a serious illness progresses. But she says making advance care planning a billable service should encourage more healthcare providers to do the same.

Brown University researchers have found that the increasing use of hospice care at the end of life has increased health care spending. That’s contrary to what experts expected.

Hospice is for patients with a terminal illness who are ready to forgo more aggressive treatments. It’s supposed to be less expensive. But Brown University researcher Pedro Gozalo says the numbers tell a different story. He found more people entering hospice, staying longer, and driving up costs. Gozalo said he supports the use of hospice care.

In 2013, the top prescribed drug for Rhode Islanders with Medicare drug plans was Omeprazole, a treatment for heart burn, ulcers, and gastroesophageal reflux disease. Health care providers wrote about 190,000 prescriptions for it.

(Reminder: Medicare is the health benefit plan for people over the age of 65 or disabled adults.)

That's followed by atorvastatin calcium (brand name Lipitor), used for lowering cholesterol - prescribed to 27,000 individuals.

A rising tide lifts all boats. That’s the finding of a Brown University researcher who investigated whether hospital quality improvements brought better care for minority patients as well as white.

Brown University professor Amal Trivedi wanted to know if improved standards at hospitals have helped all patients equally.  Medicare asked hospitals to start reporting certain quality measures in 2005. Trivedi said that at that time, there were significant disparities between the care whites and minorities got at hospitals around the country.

My recent story about the high cost of new hepatitis C treatments focused on the difficulty of deciding who gets these new drugs now and who has to wait. That's because, while new drugs like Sovaldi and Harvoni (both made by Gilead) promise to cure a lot of people, they're so expensive we simply couldn't afford to treat everyone who's infected right now.

October 15 marks the start of open enrollment for anyone who wants to switch Medicare Advantage plans or join Medicare Part D, the prescription drug plan.

November 15 is when open enrollment begins for HealthSource RI, the second time around for Rhode Island's online health insurance marketplace for individuals, families, and small businesses.

Here's what we know so far about the options.


U.S. Sen. Jack Reed, D-R.I.,  has joined with fellow Democratic senators Elizabeth Warren of Massachusetts and Dick Durbin of Illinois in urging President Obama to use an executive order to reduce or get rid of tax breaks for companies that move their headquarters overseas to avoid paying U.S. taxes.

In  letter to the president the three Democratic senators stated that while Congress considers a legislative solution there is a need for swift action by the president.

Aaron Read / RIPR

You may have gotten a letter in the mail recently from your health insurance company asking whether you wanted to opt out of something called an “all payer claims database.”

It's pretty basic: in order to save a little money, most people have to stick to a budget. But before you can sketch out that spending plan, you need to know where your money's been going and how much you've been spending on everything. Then you can look for places to trim and skimp.

So too goes the theory with health care spending. Or at least, that's the idea behind several new efforts:

Aaron Read / RIPR

New rules for Medicare Advantage plan members give seniors more flexibility to opt out of plans that drop their doctors from the network.

The Centers for Medicare and Medicaid Services has announced that Medicare Advantage plan members will be able to switch plans if those plans drop doctors mid-year without cause. These are Medicare plans offered by private insurance companies and often operate like HMOs.

Thousands of Rhode Islanders have signed up for health insurance in recent weeks, some for the first time. I'm thinking that means some might not be so familiar with our health care system, or they might not know how to keep costs down with plans that carry higher deductibles or out-of-pocket costs.

So... here are a few tools to help you navigate, from finding the highest quality, to keeping costs down, to managing your own health. It's not an exhaustive list, but a start...if you're starting from scratch!

Connecticut doctors sued United Healthcare for dropping them from their Medicare Advantage network. Will Rhode Island follow suit?

Probably not, says Steven DeToy with the Rhode Island Medical Society. He told me he thinks it's unlikely the doctors will have any luck in court because United had the right to drop doctors - it's in their contract. And if they did, it could get expensive and messy: doctors could be responsible for half the cost of mediation if it comes to that.

A federal judge in Connecticut is blocking United Healthcare’s move to drop hundreds of doctors from its Medicare Advantage network.

The Hartford Courant reports that the Fairfield and Hartford County Medical Associations convinced the court that removing the more than 2-thousand doctors in Connecticut from the health insurance network would be too damaging. And that the insurer plans to appeal the decision.