Neighborhood Health Plan to coordinate care for Medicare-Medicaid 'dual-eligible' patients

April 29--People with complex, chronic medical problems who are covered by both Medicare and Medicaid are some of the most challenging and costly patients for government insurance programs.

Now, to better and more efficiently coordinate the care of these so-called "dual eligibles," the state and federal government have partnered with Neighborhood Health Plan of Rhode Island to manage the health of these patients.

The three-way contract is intended to help control costs for the estimated 10,000 to 14,000 people expected to enroll in the new plan, Integrity, which launches this summer. Patients tend to be seniors or adults with disabilities and who are financially disadvantaged.

Only 12 other states have received approval from the federal Centers for Medicare and Medicaid Services for such a dual-eligible managed care program.

"Neighborhood has a long and successful record of working with the state, the community health centers and others to improve member access to high-quality services at a price taxpayers can afford," Peter M. Marino, president and chief executive officer for Neighborhood, said in a statement.

"This new work to integrate Medicaid and Medicare benefits and help some of Rhode Island's most vulnerable people represents our biggest opportunity to date. We believe we will be able to make a major difference by getting these new members the right care at the right time and controlling the corresponding costs."

With Integrity, each member will have a care coordinator to help access primary and behavioral health care, social services, long-term support and hospital visits.

The administration of Governor Raimondo embraces the program as part of her Reinventing Medicaid initiative.

"Through this new initiative, we are improving access to high-quality care and creating a system that is more efficient, coordinated and responsive to Rhode Islanders' needs," Raimondo said in a statement.

Neighborhood, as part of the first phase of the state's Integrated Care Initiative, launched Rhody Health Options to coordinate Medicaid services for patients with Medicare and Medicaid. Integrity goes a step further to coordinate both Medicare and Medicaid benefits.

"Since the beginning of Medicaid-managed care more than 20 years ago, Neighborhood has been a strong and consistent partner in the state's work to control costs and improve care for people in managed care programs," Health and Human Services Secretary Elizabeth Roberts said. "We look forward to continuing to collaborate with Neighborhood and the federal government on this innovative new initiative, which will strengthen the quality of care provided to some of our most vulnerable neighbors."

rsalit@providencejournal.com

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Twitter; @RichSalit

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