Neighborhood Health membership grew 20% in 2021, CEO cites impact of pandemic, looks at hospital merger

Posted 2/9/22

From one perspective the past year of the pandemic has been the best of times for the Neighborhood Health Plan of Rhode Island that saw a 30,000-member increase in Medicaid enrollment - 20 percent - …

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Neighborhood Health membership grew 20% in 2021, CEO cites impact of pandemic, looks at hospital merger


From one perspective the past year of the pandemic has been the best of times for the Neighborhood Health Plan of Rhode Island that saw a 30,000-member increase in Medicaid enrollment - 20 percent - statewide.

From another vantage, the increase in Neighborhood’s membership to nearly 217,000 is reflective of the pandemic’s impact on the economy and persons eligible for Medicaid.

“When you see that kind of growth in Medicaid rolls it’s a reflection of people struggling to either keep jobs or have jobs that pay sufficiently,” Neighborhood president and CEO Peter Marino said in a recent interview.

During 2021 the rolls of Warwick Neighborhood’s Medicaid membership increased by 1,672 members (26 percent), Cranston membership by 2,028 (26 percent), and Johnston by 725 members (23 percent).

Marino observes that the Affordable Care Act has been instrumental in ensuring that access to health insurance, not just through Medicaid but the Exchange, to the point where less than 4.5 percent of Rhode Islanders don’t have health insurance.

Looking ahead, Marino doesn’t expect to see continued growth at the levels of last year and that when the government lifts the state of emergency it will give the state permission to do more work with people who are on Medicaid to make sure they remain eligible.

He also commented on the proposal to merge Lifespan and Care New England that is under consideration by the Federal Trade Commission and the Rhode Island Attorney General and Department of Health.

Regardless of the outcome of the merger plan, Marino said it is important that the systems, or a combined system, are “committed to continuing to push the envelope so that we can improve the quality of care across the state.” He said it is likewise important “we clearly understand what I would describe as the downstream impacts on the balance of our healthcare infrastructure as well.”

Naming Comprehensive Community Action Program (CCAP), Blackstone Valley and Tri County he said the state has great health centers and hospitals, “that need to be explored very carefully to make sure we do not jeopardize what I would describe as other critical health care assets.”

“We’ve been very fortunate, Neighborhood was founded by the community health centers. And I think that’s been part of the secret sauce of Neighborhood and managed care in the state is that they have essentially served as the state’s public infrastructure,” he said. “Without high quality community health centers, I don’t think anybody would see the health care system in the state the way it is today.”

Marino added, “we have to respect their (CNE and Lifespan) scale in the market power now” as well as understand what it would be post-merger.

“I would argue that as you explore the merger you have got to make sure that you understand that this does create even more cost challenges.”

He said studies across the country “have demonstrated that these types of mergers result in higher costs.”

Furthermore, Marino believes it important that there is a better understanding of the financial positions of hospitals, not just those involved in the proposed merger so as to make sure there’s a “holistic strategy and approach making sure the hospitals can be financial successful, but at the same time meet the needs of the state.”

In a release issued last month, Neighborhood highlighted “significant achievements” of 2021 demonstrating the commitment to ensure “Rhode Island’s low-income populations have access to high quality health care.”

Cited is the 2021 Consumer Assessment of Health Care Providers and Systems (CAHPS®) Medicaid Adult Member Satisfaction survey, members' feedback placed Neighborhood as the No. 1 Medicaid Health Plan in the country for Rating of Health Plan. The national survey measures Medicaid members' experiences with health plans and associated providers, and is used as one of the quality measures in the National Committee for Quality Assurance's (NCQA's) Health Plan Rating and Accreditation.

Also listed is Neighborhood’s 5-star rating from NCQA for the Prevention component of the annual Health Plan Rating. The Prevention rating is based on nine different measures of clinical excellence. Neighborhood is one of only two Medicaid Health Plans out of 185 across the country to achieve this rating in 2021 and the only Medicaid Health Plan to do so in Rhode Island.

“What began as a dream by Rhode Island's community health centers and the state's initiative to build RIte Care, Rhode Island’s Medicaid managed care program, has evolved into a health plan with a history of delivering high quality health care to those who are most often at-risk for poor health outcomes,” Marino said in the release.

“To be consistently rated a top Medicaid plan in the country demonstrates the trust our employees and provider network have earned from our members and, in 2021, to be the number one Medicaid health plan in the country makes me tremendously proud given the challenges we have faced together during the pandemic.”

Neighborhood Health Plan of Rhode Island (Neighborhood) is a not-for-profit health maintenance organization (HMO) founded in December 1993 in partnership with Rhode Island’s Community Health Centers and the state to ensure everyone in Rhode Island has access to high quality, cost-effective health care.

Neighborhood serves nearly 217,000 members in the state with 81 percent of its membership Medicaid eligible through its ACCESS and TRUST plans and 6 percent of its membership utilizing Neighborhood's INTEGRITY Medicare-Medicaid Plan (MMP).

About 13 percent of Neighborhood's members are individuals, families and small businesses who select one of eight Neighborhood commercial plans available through the health exchange, HealthSourceRI. Of these members, about 85 percent qualify for federal subsidies to cover a portion of their costs. Today, Neighborhood - with over 600 employees and $1.4 billion in revenue - serves one out of every five Rhode Islanders.

Neighborhood Health, hospital merger


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