Managed-care program for low-income seniors
In the first collaboration between the state’s two nonprofit health insurers, Blue Cross & Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island have teamed up to offer a new Medicare managed-care plan to low-income subscribers.
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The new plan, called BlueCHiP for Medicare Optima, is available, at no cost, to people who are eligible for both Medicare and Medicaid. It provides unlimited prescription drug coverage with low co-payments, health and wellness programs and extensive preventive care.
In addition, it covers dental benefits, vision care, hearing aids and chiropractic services.
But what’s special about Optima, officials from both companies agree, is the way it brings together each partner’s expertise: the Medicare savvy of Blue Cross, which covers tens of thousands of seniors through its Medicare Advantage and “Plan 65” supplemental plans, and the Medicaid expertise of Neighborhood, the biggest participant in RIte Care and a leader in developing care management programs and support services for needy populations.
By teaming up, both companies say, they can provide something that most low-income Rhode Island seniors have never had – a health plan that works closely with them to keep them healthy and out of the hospital and helps them to take better care of themselves.
Neighborhood will provide customer service and medical management, while Blue Cross will handle sales and marketing, enrollment, claims, provider contracts, network management and underwriting. Enrollment began Nov. 15, with an effective date of Jan. 1.
Blue Cross already serves about 3,000 Medicare and Medicaid “dual eligibles,” according to Jim Gallagher, director of individual sales, and about half are a good match for Optima. Add new subscribers, and Gallagher said he expects 5,000 Optima members by the end of 2006.
Optima is not the first health plan in Rhode Island to target “dual eligibles.”
UnitedHealthcare of New England has a product called Evercare that is geared to frail seniors, often in nursing homes or receiving home-based services, who need intensive care management. It’s available to both Medicare-only and Medicare/Medicaid beneficiaries.
But Optima is geared to a different demographic, Gallagher said. Instead of the frail elderly, its focus is seniors who are still out in the community, he said, but who may have serious health conditions or face socio-economic barriers and could use some extra support.
“There are not a lot of options for these people,” he said, “so Optima is a great new product for them.”
With its primary clientele, RIte Care beneficiaries – low-income children and their families – Neighborhood is known for providing soup-to-nuts services: not only comprehensive medical care, but nurse-staffed help lines, asthma management programs, educational sessions for parents, even transportation to the doctor’s office and interpreters for non-English speakers.
Recently, in a pilot program called ConnectCare, Neighborhood has worked with state officials to develop care management programs and other supports for adults with significant health problems and/or disabilities, said Beth Marootian, director of business development.
Many of the new strategies developed through ConnectCare, Marootian said, can now be applied to Optima.
From Neighborhood’s perspective, CEO Mark E. Reynolds said, Optima is a natural extension of its longstanding mission, to help “underserved populations.” But Neighborhood has no Medicare license, so the plan will operate under Blue Cross’ license.
Getting to this point, however, has required a lot of work, both sides acknowledged. The idea grew out of conversations last year between Blue Cross CEO James E. Purcell and then-Neighborhood CEO Christopher F. Koller, now the state health insurance commissioner, and after they identified the Medicare/Medicaid population as an “area of opportunity” to collaborate, company officials worked for more than a year to develop the joint plan.
So asked whether this was the first of, potentially, several joint endeavors, Ray Brown, assistant vice president for program management at Blue Cross, said this has been “a pretty major initiative” that “has pretty much consumed” both partners’ resources.
“From my understanding,” he added, “our approach is to get this up and running and successful and, at that point, we may or may not begin to explore other opportunities.”
Reynolds, for his part, said Neighborhood has no “current plans for further efforts with Blue Cross or other partners,” though he wouldn’t discount future collaborations.
“We want to remain focused on our mission,” he said. “We’re not interested in jumping into the mainstream market. We are interested in providing services for other underserved populations.”
