In September, Mark Cooper was named vice president of Medicare-Medicaid Product at Neighborhood Health Plan of Rhode Island after working for nearly 20 years in various government and private health and insurance programs.
In his new role, Cooper works closely with the Centers for Medicare and Medicaid Services and the R.I. Executive Office of Health and Human Services. Both agencies partner with Neighborhood on its Medicare-Medicaid plan.
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PBN: In September, you were named Neighborhood’s vice president of Medicare-Medicaid Product. What prompted you to move from Clearlink Partners, where you were vice president of clinical solutions, to Neighborhood?
COOPER: I had a strong relationship with Neighborhood through my position at Clearlink and as such was drawn to its culture of serving Rhode Island’s at-risk populations and attracted by the opportunity to evolve its Medicare-Medicaid Product – known to members as INTEGRITY.
Specifically, regarding my attraction to the role of leading Neighborhood’s INTEGRITY health plan, I wanted to play a role in innovating and growing the plan since it serves Rhode Island’s most medically fragile and economically disadvantaged residents. These are typically underserved seniors or adults with disabilities who have a wide range of health care needs.
As vice president of the MMP plan, I have an exciting and meaningful opportunity to enhance the plan and to implement a strategy for continued business growth, which lies in the Medicare- and Medicaid-eligible and long-term services and supports marketplace.
Additionally, I am proud to be part of the Neighborhood team. The employees at Neighborhood have a powerful sense of purpose to address the health needs of our members in a passionate, personal way, permeating every aspect of our work. It shows in the organization’s long history of excellence, with Neighborhood being recognized with high marks for most of its 25 years by national accreditation organizations like the National Committee for Quality Assurance. Plus, the federal Centers for Medicare and Medicaid Services named Neighborhood a top-scoring plan for “Overall Rating of Health Plan” as a result of the 2019 Consumer Assessment of Healthcare Providers and Systems survey for the INTEGRITY plan.
PBN: Neighborhood is the sole health insurance plan to offer a Medicare-Medicaid option in Rhode Island, and it recently announced a three-year extension with the Centers for Medicare & Medicaid Services and the R.I. Executive Office of Health and Human Services to continue the program through 2023. What are the benefits of offering this option?
COOPER: First, let me say how excited and honored we are to have earned this extension. It affords us the opportunity to continue doing something very important to us: help some of Rhode Island’s most vulnerable residents by making it easy for them to access the services they need so they can enjoy long-term stability and health.
The extension also reflects the level of trust that the state has placed in us. The Executive Office of Health and Human Services saw the success of our first three years and knew from our long history of working together that we willingly take on challenging programs and have a distinctive ability – based on our founding by the state’s community health centers – to meet the needs of at-risk Rhode Islanders.
Our strong performance on key outcome measures established prior to the 2016 launch of INTEGRITY validates the great work we have done in partnership with EOHHS, CMS and terrific providers in the community to build a nationally recognized MMP program that provides first-class care coordination for eligible members.
With regard to the benefits of INTEGRITY, there are many. Key benefits include coordinated care teams; a person-centered approach to care; no plan copays, 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.
This proven model supports integration of health care services, including primary care, behavioral health, around-the-clock care management, access to housing and rehabilitation specialists, and LTSS. Additionally, our members benefit from the alignment goals of this program that support the coordination of services for high-need, dually eligible beneficiaries with complex chronic physical, developmental and behavioral health conditions, resulting in better care for our members.
PBN: Did demand for your Medicare-Medicaid health plan change once the COVID-19 pandemic hit?
COOPER: The pandemic had no impact on demand for, or enrollment into, our INTEGRITY plan. What it did do, however, was validate how nimble and adaptable we are for our members – especially in the face of adversity.
When the pandemic hit, Neighborhood quickly adapted and innovated by providing members telehealth options to ensure they received uninterrupted and necessary health care during the public health crisis. In addition, Neighborhood worked to identify members at the highest risk for contracting COVID-19. We then mobilized our clinical teams to conduct targeted care management outreach efforts. This work was supported by our ongoing relationship with the Rhode Island Quality Institute – who were able to provide timely COVID-19 lab results that we integrated into our daily care management planning.
As part of our wellness checks, our care management team applied an “every call, every issue” strategy to uncover concerns related to the pandemic. Because of this work, Neighborhood identified members having urgent food security issues due to the pandemic and we were able to put in place an emergency food program that allowed food to be delivered to members that very evening. We also invested in the state’s network of local food pantries, as well as Meals on Wheels of Rhode Island, knowing many families had lost jobs and that there had been an increased need for seniors to have meal delivery.
Additionally, when identified as a need, Neighborhood made available to members free digital blood-pressure cuffs and digital scales. After learning of members’ concerns around medication and finding a primary care provider, we extended the prior authorizations for medications, allowed for early refills and coordinated free home delivery, and we removed primary care provider requirements and developed a telehealth policy that did not require prior authorization.
Additionally, Neighborhood has been supporting providers with essentials such as sanitizer, pulse oximeters, digital thermometers, automatic blood-pressure cuffs and scales to distribute to our members. We have also provided personal protective equipment to providers to ensure both member and provider safety.
PBN: As Neighborhood’s Medicare-Medicaid plan, which was launched in 2016, moves into its extension, are there any goals that you are hoping to meet?
COOPER: Yes, there a number of exciting goals, both short-term and long-term, that I am looking forward to achieving. These goals include implementing INTEGRITY health plan growth through EOHHS and CMS-approved passive enrollment, which started on Jan. 1. We are expecting nearly 2,000 new members in 2021 and are putting plans in place for this expansion.
In addition, our COVID safe enrollment campaign is underway. It has been effective, but our staff really miss being out in the community, educating and enrolling folks in person. We look forward to being back in the community once it is safe to do so.
My team is also working on LTSS resiliency and rebalancing. This important work will ensure programs and services are in place to allow members to remain safely at home. We are also partnering with EOHHS to support LTSS providers of home and community-based services, including self-directed models, home health workforce development, shared and assisted living, and adult day health, to name a few. On the horizon are plans to collaborate with EOHHS on innovative payment models.
One of the INTEGRITY initiatives that I am especially excited about is a collaboration with the Community College of Rhode Island’s Workforce Development team. Neighborhood recently partnered with CCRI to fund a grant to support tuition and fees for 24 students to obtain certified nursing assistant certification. This workforce-development program starts in February and will eventually place 24 students into the workforce of nursing homes and home care providers in the state. The positives are two-fold: jobs for students and well-trained CNAs to support our INTEGRITY members.
PBN: You are also a registered nurse and respiratory therapist. Do you miss working with patients, especially now as COVID-19 has caused respiratory problems for so many people?
COOPER: Although I am no longer a direct-care provider to patients, I continue to have an impact on patient care through my role at Neighborhood. The work I do is fulfilling in a more indirect way, giving me the opportunity to affect the quality of our patient care, services and support.
Elizabeth Graham is a PBN contributing writer.
