MINDSETTER™ Croke: Innovative Partnerships Help RI Residents Get Healthy, Save Money & Make History

Tuesday, August 23, 2016

Guest Mindsetter™ Alison Croke

 

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Alison Croke

It’s exciting to see the Ocean State be at the head of the pack when it comes to improving the current health care system, and that’s just where we are this summer.    

As of July, Rhode Island has joined a group of 13 states allowed by the federal government to offer a new and innovative health care option.  It is available only to people who receive both Medicare and Medicaid benefits.  These Rhode Islanders are often older adults with low income who have more than one illness or health complication.  This special Medicare/Medicaid Plan is often called an “MMP”.

Neighborhood is the only Rhode Island health insurer allowed to partner with the state and federal government in this endeavor. Neighborhood’s MMP is called INTEGRITY.

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Medicare and Medicaid benefits are literally lifesavers for tens of thousands of Rhode Islanders.  But with one set of benefits offered by the state and the other by the federal government, getting what you need can be complicated and frustrating.  An inefficient process wastes time, costs more money than it should and might stop patients from getting the care they require.

Folks who are eligible for both Medicaid and Medicare benefits know firsthand how confusing the healthcare system can be. INTEGRITY is built to fix that system. Now, Neighborhood Health Plan of Rhode Island’s members enrolled in that plan will only have to worry about carrying one identification card to the doctor’s office.  One card – that’s it – for the whole suite of Medicare, Medicare Part D (prescriptions), and Medicaid benefits.  Members will also never have to worry about plan co-pays; there are no plan co-pays with INTEGRITY.  But best of all is what’s happening behind the scenes: Neighborhood’s members will benefit from first-class care coordination.  

The aim of INTEGRITY is to encourage doctors and providers to work together on interdisciplinary care teams. Putting the requests of the member first, medical professionals will collaborate on healthcare plans that focus on the quality of the treatment people receive, not on the number of tests that are ordered.  The end result will be healthier people at a reduced cost.  And it’s already working.

INTEGRITY is the second phase of a partnership that Neighborhood began with the state back in 2013.  Since the start of phase one, Neighborhood has helped reduce the number of people living in nursing homes by 12%, in part because we supported efforts to help keep people living independently in their own homes.  Because of the close eye we keep on our members, we were also able to reduce Emergency Room visits by 11% and lower hospitalizations by 6% over that same time period. 

Behind those statistics are thousands of Rhode Islanders who are happier and healthier thanks to our collective work to help our elders age well.  The collaboration that starts this summer among Neighborhood and the state and federal government will make these stories even happier ones to tell in the coming years.

Alison Croke is the Vice President of Medicare-Medicaid Integration at Neighborhood Health Plan of Rhode Island.

 

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