A new report on Rhode Island’s commercial health plans shows they compare favorably with regional and national quality benchmarks, and most of their subscribers are satisfied with the care they’ve gotten, but hospitalizations and emergency room use in the state are well above average.
The report, issued by the R.I. Department of Health and based on 2004 figures, looks only at the directly insured market – as opposed to self-insured groups – and focuses on the three largest carriers: Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare of New England, and Blue Cross & Blue Shield of Massachusetts.
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Blue Cross of Rhode Island and its HMO, BlueCHiP, dominated the market, with a 65.2-percent share, up slightly from 2003, the report shows. United had 22 percent of the market, up from 17.7 percent in 2003, while Blue Cross of Massachusetts stood at 8.5 percent, also a slight gain from 2003. Other, smaller plans’ share dropped to 4 percent from 12 percent.
The Blues both outperformed United in subscriber satisfaction, with 82.7 percent of Rhode Island Blue Cross and 79.5 percent of BlueCHiP members satisfied with the care they’ve received and 70.4 percent and 63.1 percent, respectively, satisfied with the health plans.
For Blue Cross of Massachusetts, the satisfaction rates were 81.6 percent and 74 percent, respectively, while United’s were only 74.5 percent for care and 55.4 percent for the plan.
On complaint rates, the Blues also did better than United, with 10.9 percent of Blue Cross of Rhode Island, 13.1 percent of BlueCHiP, and 10.9 percent of Blue Cross of Massachusetts members saying they’d complained to their insurer in the past year.
United’s complaint rate was 15.2 percent, an increase from 12.5 percent in 2003, while the Blues’ complaint rates dropped.
In terms of quality measures such as how often smokers are advised to quit; rates of colorectal cancer, breast cancer and cervical cancer screenings, and cholesterol management, the health plans all got relatively good marks, tending to match or exceed regional and national benchmarks (each plan did better on some measures than on others).
“Rhode Island’s health plans deliver preventive services, like advising smokers to quit, more often than other health plans nationwide,” said Dr. David R. Gifford, the state health director, in a news release. “However, some indicators also point to the need for better chronic care management in primary care settings. Too few health plan members receive recommended treatment for a new episode of depression, or follow-up to inpatient treatment for mental illness.”
Of even greater concern to officials was the fact that Rhode Island plans’ hospital utilization rates not only continue to far exceed the norm, but some are getting worse.
Overall, the plans’ average number of inpatient days per 1,000 members – 246 – was well above the New England average of 195 and the U.S. average of 213. United did worst, with 255 inpatient days, compared with 251 for Blue Cross of Rhode Island and 231 for BlueCHiP.
On emergency department visits, the plans averaged 196 per 1,000 members, on par with New England but well above the U.S. average of 177. Again, United did worst, with 207, compared with 190 for Blue Cross of Rhode Island and 197 for BlueCHiP.
In a news release about the report, Health Insurance Commissioner Christopher F. Koller said the data showed that “we need the health plans to do more to help improve the balance of health care delivery in Rhode Island.”
“The inappropriate use of hospital emergency departments is one driver of health care cost,” Koller added, “and greater support for primary care providers in Rhode Island by health plans could lead to more cost-effective care delivery and improved performance on these measures of clinical quality and access.”
A spokesman for United did not reply to a request for comment. Kim Keough, spokeswoman for Blue Cross, said ER use is “definitely an issue” for her company, “and we are looking at ways in which we can better educate our members about appropriate use of ER services.”
In fact, Keough noted, a new Blue Cross contract with the University Emergency Medicine Foundation, whose members treat patients in the ERs of Rhode Island Hospital, Hasbro Children’s Hospital and The Miriam Hospital in Providence, includes a provision that they “educate” patients about “appropriate use of ER services.”
The full report is available at www.health.ri.gov.
