neighborhood health plan of rhode island

Kristin Gourlay / RIPR

Here’s what’s happening in health care in Rhode Island.

Cynthia Goldsmith / CDC

Here’s what’s happening in health in Rhode Island (for 7/19/16 - 7/26/16): federal drug czar visits, a new college at URI, community health grants, Zika funding, addiction treatment, a sports program for disabled veterans, and a health system merger proceeds, but not as quickly as the parties would like.

Kristin Gourlay / RIPR

State health officials say we’re spending too much on nursing homes. Instead, they say, we could be caring for people, for less money, at home.

 

Providence Business News Editor Mark Murphy joins Rhode Island Public Radio's Dave Fallon for our weekly business segment, The Bottom Line.

This week, Mark and Dave speak with Neighborhood Health Plan President and CEO Peter Marino. Neighborhood Health is launching a new initiative aimed at streamlining the sometimes thorny process of navigating Medicaid and Medicare.

When to listen:

You can hear The Bottom Line each Friday at 5:50 p.m.

Health insurers have put in their requests for the rates they hope to charge consumers in 2017. Most have asked for increases, but not all.

Every year insurers have to figure out how much it cost them to pay for medical care for all of their members, and how much they think it will cost next year. It’s a complex process, and state regulators don’t always agree with insurers on the numbers. The result directly affects what you pay for health insurance each month.

Neighborhood Health Plan of Rhode Island, which manages thousands of the state’s Medicaid patients, has found a way to bring down health costs for some of its highest need patients. The organization’s chief medical officer Paco Trilla says the Health@Home program targeted about 450 patients with multiple chronic conditions. They were using a lot of medical services, but not getting better.                

Or... they could be. Insurers have just filed their requests for premium rate increases with the state’s health insurance commissioner. They’re only preliminary. And in years past the health insurance commissioner has denied some increases. But if experience is any guide, the average monthly premium for most plans will probably go up - in some cases by two-digit percentages.                                                         

It all depends on how you buy your insurance - on your own, through a small business, or through a large business.

Patient-centered medical homes. Community health teams. Accountable care organizations. Integrated medical and behavioral health care practices. Case management.

Jargon?

Health insurers have filed their requests for rate increases (or, in one case, decreases!) for the coming year (effective January 2015). The Office of the Health Insurance Commissioner reviews those requests to make sure they're fair, and then issues a ruling, probably by mid-July. Before then, you have an opportunity to weigh in.

Here are the details on those opportunities, plus OHIC's summary of what insurers have requested.

Rhode Islanders who are covered by both Medicare and Medicaid - the so-called "dual eligibles" - take note: you're being enrolled in a new health plan designed to coordinate your primary care and long term care needs a bit better. It's called the Integrated Care Initiative, it could affect nearly 28,000 Rhode Islanders, and it's not without controversy.

But first, what's it about?

Rhode Islanders who buy health insurance individually or through a small employer now have an idea how much their monthly premiums will be in 2014. The state’s outgoing commissioner of health insurance approved rates lower than insurance companies requested, although just about everyone’s health insurance bill will be going up.