SMITHFIELD – The state’s Office of the Health Insurance Commissioner report on 2018 coverage rates on Rhode Island’s health insurance exchange marks Neighborhood Health Plan of Rhode Island’s options the most affordable, which the nonprofit attributes to proactive attention to members’ health and wallets.
Neighborhood requested and received permission from the state to increase its individual and family plans by 5 percent. It also requested and received permission to raise the price for its Small Business plans (between 2-50 employees) by an average of 6.3 percent. Neighborhood’s rates remain the lowest available on the state’s health insurance exchange, HealthSource RI.
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“We keep rates low by helping our members stay healthy. One of the ways we do that is with a vibrant case management program,” said Neighborhood President and CEO Peter Marino.
Neighborhood members who qualify for case management get access to a team of medical professionals, often including a nurse and a social worker, helping them follow their doctor’s care plan, Marino said.
Neighborhood’s community outreach workers also serve on the teams, connecting members with social services such as housing, heating, or food assistance that allow them to focus on their health, he said.
Neighborhood also strives to make sure members take care of themselves. Neighborhood’s member rewards program offers incentives including gift cards for adults and bike helmets for kids to encourage annual checkups and immunizations.
“If we can help our members stay healthy, they’re happier because of that – and it saves money, which is always important for a nonprofit,” Marino said.
Although Neighborhood’s rates remained the lowest, they did rise after last year’s request to lower the charges.
Marino said a combination of rising pharmaceutical costs and expenses incurred while expanding their network of doctors and medical professionals required a rate increase this year.
Price increases for medicines outstrip inflation and exceed other health care expenses such as hospital days and physician costs, he said. For example, from 2015-2016, Neighborhood saw a 47 percent increase in overall per-member/per-month pharmaceutical costs, Marino said.
“Our chief medical officer, Dr. Francisco ‘Paco’ Trilla, often talks about the fact that Neighborhood has experienced several years of increases in excess of 10 percent for essential medications, including insulin, which have been around for decades. We see such price hikes as unjustified and we believe they are the major cause for premium increases.”
Expanding Neighborhood’s provider network also added to costs this year.
“To achieve that goal, we sometimes have to increase the rates we pay our providers. We did that in 2016, and that also played a role in our commercial rate increase,” Marino said.
Marino said Neighborhood’s nonprofit status and its focus on its role as a steward of taxpayer money with so much of its business connected to the state’s Medicaid program also inspires its low 8 percent administrative-costs ratio.
“Other health insurers brag when their admin ratio drops below 20 percent. Neighborhood is always looking for ways to innovate and to encourage savings – particularly when we can do that and make our members healthier at the same time. Any health insurer is free to follow our lead, as long as they prioritize the health of their members before their profits,” Marino said.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
