Blue Cross Blue Shield of RI

Remember last summer when Attorney General Peter Kilmartin took the Health Insurance Commissioner to court over her decision on Blue Cross rates for individuals? Well, there are now some encouraging signs that these two government agencies are ready to patch things up.

At the House Committee on Corporations meeting Tuesday, representatives from the AG’s office and the Office of the Health Insurance Commissioner (OHIC) spoke in favor of compromise legislation that would allow both agencies to continue to be involved in health insurance rate approvals under certain conditions.

At the center of the issue is the unique process that Blue Cross & Blue Shield of RI (BCBSRI) is subject to when it comes to their individual plan rates.

All Rhode Island health insurers must submit any proposed rate changes to OHIC for approval before they can take effect – an annual process called “Rate Review.” OHIC staff dig deep into the insurers’ justification for their new rates, perform their own actuarial analyses, and solicit public comment from consumers.

This Rate Review process applies to all commercial health plans, except for BCBSRI’s individual market offerings – so-called “DirectPay” plans. That’s because an antiquated law from back when BCBSRI was the only option available to a consumer who wanted to purchase a health plan direct for his or her family.

The law subjects any proposed rate changes for the DirectPay plans to a special and totally separate process that involves the AG’s office and includes a formal hearing with a hired hearing officer where any consumers wanting to speak must testify under oath. These separate processes have confused consumers – we’ve been at Rate Review public comment sessions where DirectPay subscribers have come to speak only be to shut down by the Commissioner, who legally cannot hear their comments.

But the legislation submitted by Representative Mary Duffy Messier on behalf of the AG’s office would subject all health insurers to the same process and call for a formal public hearing and notification of the AG’s office only when the requested rate increase is 10 percent or more. It also allows OHIC to still hold the less formal public input meeting even if a hearing is necessary, allowing greater consumer access to participation in the process.

The AG’s office, OHIC and Blue Cross all signaled general support for the bill when it was heard in committee on Tuesday. The bill was held for further study.

Last year, the Attorney General disagreed with the Commissioner’s decision on the DirectPay rates and took her to court. OHIC ultimately won, but the legal spat held up rate approvals.

Both the Attorney General and the Health Insurance Commissioner are working in good faith to protect consumers, and this legislation lets them both continue to have a role in rate approvals. It will strengthen consumer protection, preserve consumer access to the process, and best of all, it will finally correct an outdated law and subject all health insurers to the same fair process.

Imagine a plan sitting at the RI Department of Health (RIDOH) that would reduce health care spending in Rhode Island by 15 to 30 percent. A plan with the added benefit of improving health care outcomes “with a cutting edge technology that brings every Rhode Islander into world class care – as they need it, where they need it, when they need it, in a way that builds community instead of building profit for others.”

Neighborhood Health Stations, developed by the RIDOH under the leadership of Dr. Michael Fine, is that plan.

Neighborhood Health Stations are “basically community hospitals without walls,” says Dr. Fine in conversation with Richard Asinof of ConvergenceRI. Dr. Fine planned to build one station for every 12,000 Rhode Islanders, between 75 and 100 such stations in all. The first one was to be built in Central Falls.

Neighborhood Health Stations would locate pediatricians, internists, family physicians, dentists, nurse practitioners, licensed and registered nurses, advanced practice nurses, physician assistants, mental health and social workers, physical therapists and occupational therapists, pharmacists, emergency medical technicians and paramedics, registered dietitians, home health workers, promotoras, health coaches, navigators and other healthcare workers under one roof, in a facility that would also offer programs such as “nutrition courses, Zumba classes, or group counseling sessions.”

According to Dr. Fine, if we implemented this plan, we could shrink the hospital system in our state. “When you build out the full delivery system of one neighborhood health station for every community of 12,000 people,” says Dr. Fine, “it is very likely that we can reduce the total number of hospital beds by 40 to 45 percent. That means dropping [the number of hospital beds in Rhode Island] by about 900 beds.”

Governor Gina Raimondo’s budget proposes cutting $88 million from Medicaid’s $2.7 billion in spending, a 3 to 6 percent reduction. Since “Reinventing Medicaid” is being presented as an answer to an imminent disaster, improving the quality of health care or paying adequate wages to health care workers is taking a back seat to saving money.

That’s a shame, because a fully realized health care system of the kind imagined by Dr. Fine would attract business and investment to Rhode Island, while draconian cuts in services to our most vulnerable will have the opposite effect. If we could build Neighborhood Health Stations and make them work, “then health care spending becomes a business magnet. People come and locate businesses here, just because of our health care,” says Dr. Fine.

It’s a great idea, but not one that’s likely to happen. Since Dr. Fine’s departure, Neighborhood Health Stations seem in jeopardy. The new head of the RIDOH, Dr. Nicole Alexander-Scott, has yet to comment on the plan. But a more immediate reason for the plan’s quiet demise can be intuited.

“…if I have had one failure [while serving as director of the R.I. Department of Health],” said Dr. Fine, “if I want to be self-critical, [it’s] that I haven’t made it clear enough to people that we don’t have a problem with insurance, the problem is insurance. That thinking, that insurance, as a financial mechanism, can impact health, is a fundamental, categorical mistake.”

Dr. Fine saw his Neighborhood Health Stations as saving money by cutting out for profit insurance companies, and actually reducing the size of hospitals. The Reinventing Medicaid working group is comprised of a diverse group of people, but for-profit insurers and health-care providers have a prominent seat at the table. Timothy Babineau, MD, president and CEO of Lifespan, Peter Andruszkiewicz, president and CEO of Blue Cross Blue Shield of RI and Helena Foulkes, executive vice president of CVS Health and president of CVS/pharmacy will ensure that their corporate, for-profit interests are protected.

To Dr. Fine, Neighborhood Health Stations are the future of health care. “…if we don’t do it, all we’re doing is perpetuating a costly infrastructure that doesn’t work.” An infrastructure that will remain immeasurably profitable to those sitting at the top of certain health care empires.

The “artwork was created by Roger Williams University students, in consultation with students at Rhode Island College School of Nursing, to illustrate how Neighborhood Health Stations could enhance well-being in Rhode Island communities.”

Tag: Blue Cross Blue Shield of RI

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