Affordable health care the mission

home visits: One of Neighborhood Health Plan of Rhode Island's newest initiatives includes multidisciplinary home health visits. Here Noel Hernandez, left, NHPRI community outreach specialist, and Terri Venditto, right, RN and medical case manager, visit NHPRI member Altagracia Martinez. / PBN PHOTO/MICHAEL SALERNO
home visits: One of Neighborhood Health Plan of Rhode Island's newest initiatives includes multidisciplinary home health visits. Here Noel Hernandez, left, NHPRI community outreach specialist, and Terri Venditto, right, RN and medical case manager, visit NHPRI member Altagracia Martinez. / PBN PHOTO/MICHAEL SALERNO

Neighborhood Health Plan of Rhode Island is devoted to making lives better.

“There is a clear mission in everybody’s day-to-day work,” said Peter Marino, CEO and president of the Smithfield and Providence-based nonprofit HMO. “We want to provide great quality care at a price that at-risk populations in the state can afford.”

In the process of working toward that goal, the 23-year-old health insurer has established itself as a leader in its industry.

Over the past three years, it has experienced tremendous growth across all levels of its business. Membership grew from 92,000 in November 2013 to 190,646 by the end of October 2016, with annual gross revenue more than doubling over the same time period, from $430 million to $1.01 billion. To accommodate that growth, Neighborhood Health has expanded its staff to 468 this year from 230 in 2012.

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There are several factors that have allowed for that expansion, according to Marino. First and foremost: The Affordable Care Act. Being able to offer coverage through the state’s health insurance exchange, HealthSource RI, opened the HMO up to several groups outside of its traditional Medicaid business, including adults without dependents, seniors and the disabled, and everyday Rhode Islanders seeking coverage.

Today, one in every six state residents is enrolled in a Neighborhood Health plan, Marino said. The HMO ultimately serves two-thirds of the Medicaid population in the state.

Another initiative is its INTEGRITY program, which launched in July 2016 and is targeted to those who are “dual eligible” – or able to receive both Medicaid (which is for low-income populations) and Medicare (which is for populations over 65 or those suffering from a severe disability, no matter their income).

Rhode Island is one of 13 states working on such a program through a partnership with the federal Centers for Medicare and Medicaid Services, according to Marino, who described it as a slow and deliberate roll-out that is still in its infancy.

“Care for those who are dual eligible is typically not well-coordinated across the country,” he said. “We’re at the forefront of trying to create a new way to provide their care at a price that everybody can afford. That’s certainly one of our largest initiatives right now.”

Another relatively new program is Health@Home, which was launched two years ago and hearkens back to the roots of medicine. Analytics help to determine which patients might benefit from a certain kind of care. Once they are identified, nurses and social workers visit them in their homes and provide assessments. As Marino noted, in the process other non-medical needs are often discovered, such as housing, food security or heating issues. Their providers work with them to help resolve those needs so that they can better focus on their health.

“Primary care is really the fundamental solution to that,” said Marino, adding that, as a result, Neighborhood Health has seen a reduction of more than 30 percent of emergency room visits in that population. “It’s really a homegrown initiative here.”

Another strength is Neighborhood Health’s diversity: It has employees who speak multiple languages, and in some cases come from the populations they serve. “There’s a real good connection between our members and the folks that work here. That’s another piece of the puzzle that really has helped us be successful.”

He said the goal is to continue to develop Neighborhood Health’s diverse array of offerings and help to make the health care process easier and more accessible.

“We’ve had a very successful couple of years here,” said Marino. “We want to make sure that we stick to our fundamentals and do them well.” •

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