PROVIDENCE – It can be misleading, to say the least, to reprint a news release as a news story, as if the content was the same as what a reporter might write, painting a picture of alleged facts that may be purposefully inaccurate, distorted and manipulative, without any filter.

Take, for example, the May 31 story, with the headline, “Neighborhood Health Plan says new integrative care initiative is showing results,” which appeared in the online PBN Daily Edition.

The so-called news story, in fact, was rewritten directly from a new release issued on May 27 by Neighborhood Health Plan of Rhode Island, based upon a self-generated report by the health insurer.

[It’s apparently a common practice at The Providence Business News as part of its churning out of daily online newsletters, its “Morning Call” news summary, and its “Daily Edition,” for such rewritten news releases to appear without an actual named byline, instead appearing under the generic PBN Staff byline.

There is, however, a categorical difference between reprinting a news release, say, from Save The Bay, as PBN did in its online June 3 “Daily Edition,” with the same generic PBN Staff byline, that detailed the group’s 2016 annual environmental award winners in advance of the organization’s annual meeting on June 9, and reprinting the news release from Neighborhood Health Plan of Rhode Island, about alleged outcomes that might have distinct policy and state budget implications.]

Why mislead the reader? Why not admit, up front, that it is a rewritten news release?

More importantly, wouldn’t it be important to ask what was the intent and timing of the news release by Neighborhood Health Plan of Rhode Island – issued on the Friday before Memorial Day weekend, in what reporters often refer to as a “news dump?”

The news release – and the subsequent version that was rewritten and published as a news story – trumpeted the alleged positive outcomes of the first phase of the Integrated Care Initiative for dually eligible members of Medicare and Medicaid, originally known as Rhody Health Options and now dubbed “Unity” in a Kafka-esque turn of phrase, under the sole-sourced management of Neighborhood Health Plan of Rhode Island.

A detailed analysis of the numbers in the report, news release, and published news story, with their problematic conclusions, follows below in this story. But first, it’s important to ask and then try to answer: why the apparent distortions?

Why mislead the public and the news media?
The problem is: the numbers being promoted by Neighborhood Health Plan in the news release do not appear to be an accurate reflection of the actual program outcomes; the news release, instead, seemed to be offering misleading conclusions about the program’s success.

What was the purpose behind the apparent distortion? Was it an effort to try and influence the pending version of the state budget, to be “introduced” in the R.I. House any day now?

Further, was there any coordination with the R.I. Executive Office of Health and Human Services over the content of the news release?

Was it part of a public relations effort by Neighborhood Health Plan to counter the damaging testimony on April 28 before the Senate Finance Committee, at which one home care agency owner, Gail Sheahan of Consistent Care in Jamestown, called the first phase of the Integrated Care Initiative “horrible” and “a nightmare?”

“Phase One is so messed up, you cannot believe it; it’s a nightmare,” she told legislators. I have no idea, Sheahan continued, “why they are going to roll out Phase Two when Phase One was horrible.” Sheahan warned the members of the Senate Finance Committee: “They are selling you a bad bill of goods, people.” [See link to ConvergenceRI article below.]

The big picture
First launched in 2013 under Steven Costantino, then Secretary  of R.I. Executive Office of Health and Human Services, Rhody Health Options was envisioned as the first step in an effort to rebalance the system of care to move seniors away from nursing facilities and back toward community services, targeting those senior who were most frail and most vulnerable, the dually eligible for both Medicaid and Medicare services.

The Integrated Care Initiative in Rhode Island was one of a number of state programs being pushed by the federal government through the Centers for Medicare and Medicaid Services as a way to cut costs and improve outcomes for the dually eligible.

To date, the results of many of those state programs have been mixed if not disappointing, with some states choosing to end their efforts prematurely.

The aggressive launch by Costantino in the fall of 2013 anticipated that it would only be a short amount of time before the three-legged stool of R.I. EOHHS, Medicaid and Medicare would become a reality.

Instead, the final signed contract between all three parties, known as Phase Two, or in the newspeak of Neighborhood, “Integrity,” took almost three years to accomplish; R.I. EOHHS announced on April 28, 2016, that the three-way contract had finally been inked.

The reality was the Rhode Island program had been wobbling unsteadily on a two-legged stool during that time, encountering problems with enrollment, rollout and coordination with nursing homes and home health agencies.

It was anticipated – even boasted by its advocates at its launch – that Rhode Health Options would lead to a transfer of some 3,000 nursing home residents back to the community, creating a wave of cost savings. That turned out to be wishful thinking.

• In 2015, the total number of transitions achieved under the direct auspices of Neighborhood Health Plan under Phase One of the Integrated Care Initiative was 36, according to the state’s own public records.

• Even worse, the total number of transitions from nursing facilities back to the community have actually been reduced, not increased, when transition numbers were compared with previous programs underway before Neighborhood Health Plan became involved, according to the state’s public records.

The failure of Neighborhood Health Plan under Rhody Health Options [now called “Unity”] to achieve the promised results in transition of dually eligible members back to the community provides the larger context for the misleading news release issued on May 27.

Details, details, details
The news release claimed that Neighborhood Health Plan of Rhode Island, through Phase One of its Integrated Care Initiative program, “helped reduce the number of dually eligible members living in nursing homes by 11 percent.”

This optimistic “conclusion” was based, evidently, upon the fact that in June of 2014, Neighborhood Health Plan had a reported 3,141 dually eligible members in nursing facilities, and in April of 2016, they had a reported 2,797.

The use of those raw numbers, however, does not factor in other potential reasons for the reductions: some of the members “opted out” of the Neighborhood Health Plan program, while others died and were not replaced. Without calculating in these other reasons for reductions, the numbers are skewed, inaccurate and give an overly optimistic view of the success of the program.

That 11 percent figure also does not jibe with the most recent report sent by the R.I. Medicaid office to legislative leaders. The number of institutional patients 65 years and older receiving long-term care support services between FY2014 and FY2015 declined by only about 3 percent, from 7,807 to 7,568, according to annual report prepared by Anya Rader-Wallack, Rhode Island Medicaid director, and sent to legislative leaders on April 6, 2016. In terms of calculating the decline for a longer time period, the decrease from FY2011 to FY2015 was reported to be about 4.6 percent, falling from 7,933 to 7,568 patients who were 65 years and older.

[The total number of Rhode Island nursing home residents has, in fact, been declining since 2002, which industry advocates attribute to the growth in assisted living.] 

The inference drawn by the 11 percent

The apparent inference that Neighborhood Health Plan sought to draw, in both its report and in its news release, was that its managed care capabilities served as a major factor in the reasons behind the 11 percent reduction in dually eligible members residing in nursing home settings, based upon “more than 40,000 assessments” conducted by the health insurer.

The convergence of a customized blend of services, the Neighborhood Health Plan report said, “helps to support the member in the right setting for them, either in remaining in or transferring to the nursing home or community setting.”

Once again, the conclusion being promoted in the self-generated report was that Neighborhood Health Plan’s touted skill in managed care capability had been making a substantial difference in the quality of care for dually eligible members, an hypothesis that may prove to be wishful thinking at best.

That’s because many of the residents of nursing homes were not – and would never be – candidates to move back into the community, once a determination of care has been made. This is a result of the reality of demographics of Rhode Island – the state leads the nation in the number of “old old,” people who are 85 years and older. And, the fact that the frailer, older residents of Rhode Island are much more susceptible to the ravages of Alzheimer’s, Parkinson’s, dementia and the full flowering of chronic diseases such diabetes and heart disease, requiring constant 24/7 care.

Poor hypothesis, inaccurate numbers
The rationale used to support the premise of Rhode Health Options – and repeated in the recent self-generated report by Neighborhood Health Plan – was that “many of the folks living in nursing homes [18 percent, according to research conducted by Brown University] have been identified as having ‘low care needs.’”

The presumption, repeated in the report, was: “Those individuals, provided they were given some additional support services, could remain living where they want; typically, in their own homes.”

First, the 18 percent number being used is inaccurate, off by at least one-third; the 2014 number for such alleged “low-care” folks living in nursing homes is 12.6 percent, according to a Brown University website. Some advocates believe that the number is actually much lower than that.

Second, the underlying assumption, not yet proven, was that it would prove to be less expensive to care for people in the community, and that the state has the financial resources – and the willingness to invest those resources – to provide housing and 24/7 care in the community for the dually eligible individuals.

The testimony at the April 28 Senate Finance Committee hearing strongly undercut that kind of wishful thinking – that somehow it’s possible to rebalance care for Rhode Island’s poor and frail elderly and keep them out of nursing homes by increasing community-based services but not increasing state payments for the workers doing the real jobs.

As Deb Driscoll, president and CEO of Ocean State Nursing, testified, there will be a continuing crisis in the shortage of home health care workers if the state did not provide a major increase in pay for CNAs working in home health care.

Driscoll and her fellow home health agencies are asking for increase of the rate of reimbursement by 40 percent to make their pay equal to what it is in Massachusetts and Connecticut. Driscoll told legislators that her agency recently had to go on emergency preparedness footing, rationing care, not because of a hurricane or a snowstorm, but because of a shortage of workers. “I have never seen it this bad,” she said. “We have no staff.”

Perhaps even more amazing, Driscoll directly told Elizabeth Roberts, secretary of the R.I. Executive Office of Health and Human Services, that she was “petrified” with fear to meet with her. [See link to ConvergenceRI story below.]

Translated, it’s kind of like the old blues lyric: everyone wants to go to heaven but nobody wants to die. R.I. EOHHS is promoting the Integrated Care Initiative as a less costly alternative to nursing homes to keep people in the community but says there isn’t enough money in the budget to pay CNAs a competitive wage to provide the kind of services needed.

If it will cost more money to pay CNAs a competitive wage to make the rebalancing effort succeed, why isn’t the state willing to make that kind of investment in the people doing the real work? Is it because that kind of investment would undercut the savings projected under the reinvention of Medicaid?

Rebalancing the numbers
Finally, in looking at the numbers used by Neighborhood Health Plan in its self-generated report, the health insurer makes the claim that “less than one-quarter of Rhode Island’s dual-eligible population lives in an expensive institutionalized setting like a nursing home, yet these placements still drive almost 94 percent of Medicaid spending in long-term services and support,” citing a Kaiser Family Foundation report as the source.

The problem is that the 94 percent figure, while accurate as far as what the Kaiser Family Foundation report said, is apparently contrary to what other reports have found:

• In the R.I. EOHHS State Annual Progress Report on Long-Term Care System Reform and Rebalancing in April 2016, for the SFY15 total spending, for the population 65 years and older, institutional spending was $326,687,006, while home and community-based services spending was $56,578,178, for a total amount of $383,265,184. That breaks down to 15 percent for home and community-based services, and 85 percent for institutional services.

Why the numbers matter
In September of 2015, Providence Business News named Neighborhood Health Plan the fastest-growing large company [with revenues of $75 million or more].

The insurer went from some 92,000 members in November of 2013 to more than 175,000 members in 2015, the growth attributed in large part to new dually eligible members in both Medicare and Medicaid.

The dually eligible members “acquired” as part of the Phase One of the Integrated Care Management were also largely responsible for Neighborhood Health Plan’s doubling of its revenue, from $427 million in 2012 to $894 million in 2014. The number of employees has also just about doubled, growing from 230 in 2012 to 425 in 2014, according to the company’s news release celebrating the “fastest growing large company” 2015 award by PBN.

Earlier this year, Neighborhood Health Plan also moved its corporate headquarters to Smithfield from Providence to accommodate the company’s growth spurt, into a space on Douglas Pike previously occupied by Citizens Bank.

Translated, the rapid growth of Neighborhood Health Plan has been precipitated in large part by its sole-source contract to manage the Integrated Care Initiative, for both Phases One and Two, now known as Unity and Integrity.

Does that apparent success come with a kind of Teflon coating, protecting the health insurer and its performance under Phase One of the Integrated Care Initiative from legislative or media scrutiny?

Why has the news media been so reluctant to ask questions? Why has the R.I. General Assembly chosen not to probe more deeply?

Despite the apparent discrepancy in the numbers cited by the Neighborhood Health Plan self-generated report promoting the accomplishments under Phase One of the Integrated Care Initiative, despite the lack of promised transitions achieved by the case management under Neighborhood Health Plan, despite the testimony before R.I. Senate Finance Committee by home health agency executives that called Phase One “horrible” and “a nightmare,” R.I. EOHHS and Neighborhood Health Plan are pushing full-steam ahead with Phase Two of the Integrated Care Initiative, now called “Integrity.”

Wouldn’t it more prudent to postpone the introduction of Phase Two for a few months until all the problems identified with Phase One have been addressed and fixed? Is it the job of the Centers for Medicare and Medicaid to be the promoters or the regulators of the Integrated Care Initiative during the last few months of the Obama administration?

Moving forward
Integrity and unity are examples of the kind of branding names invented by public relations professionals that seek to attach the positive-sounding labels to alter the public’s perception of corporate or government programs. How can a health insurance program called “Integrity” lack integrity? Or, how can a program called “Unity” not be unified in its purpose, but instead prove to be divisive?

Editor's note: ConvergenceRI attempted to reach out to Neighborhood Health Plan to get their response to questions about the numbers used in the news release and the report, but did not get a response.