Delivery of Care

Upheaval in the Rhode Island health insurance marketplace

Tufts Health Plan joins forces with Lifespan to offer a tiered health plan for businesses in Rhode Island

Photo courtesy of Tufts Health Plan website.

The marketing image from the Tufts Health Plan website welcoming visitors to its health insurance platform.

By Richard Asinof
Posted 4/13/15
The entrance of Tufts Health Plan with a business plan not being offered as part of the exchange that will feature a tiered network of Lifespan physicians and hospital services as a “low-cost” alternative marks a potential dramatic shift in the commercial marketplace. The failure of Lifespan or Tufts to talk about how the new tiered plan will differ from the previous tiered plan that Tufts offered with Steward Health Plan is not a positive development.
Which competitor is Tufts targeting in the commercial marketplace – Blue Cross, UnitedHealthcare, Neighborhood, or the larger, self-insured marketplace? How much in terms of additional revenue does Lifespan project will be driven to the state’s largest hospital system as a result of the new plan? How much will that offset ongoing financial troubles with the hospital’s bottom line? Is the move a shot across the bow of Blue Cross and its position as administrator of self-insured plans to larger companies in Rhode Island? How will this impact the ongoing competition between Lifespan and Care New England for women’s health services? What will be the extra charge for women who choose to deliver their babies at Women & Infants, an out-of-service provider?
One of the costs not yet quantified in the discussion about whether or not to turn HealthSourceRI back to the feds is what it will cost the major health insurers in the state – United Healthcare, Blue Cross & Blue Shield of Rhode Island, Tufts Health Plan and Neighborhood Health Plan of Rhode Island – to have to reconfigure all their systems to fit seamlessly [hopefully] into the federal exchange. Lawmakers in the R. I. General Assembly should calculate these real costs to businesses before making a decision that the federal exchange may be cheaper. Also, Ted Nesi’s recent analysis of the costs associated with keeping HealthSourceRI as a state-run entity appeared to conflate two separate items, according to Anya Rader Wallack. One item looks at the way you calculate the base expenditures, the other looks at how the money is collected. Wallack stands by her calculation and the one done by the Senate Finance staff.

PROVIDENCE – A lawyer attending a recent corporate gathering at Blue Cross & Blue Shield of Rhode Island told ConvergenceRI that she was struck by a comment made by Peter Andruszkiewicz, the president and CEO of Rhode Island’s largest commercial health insurer.

Andruszkiewicz, the lawyer said, had talked about his disappointment with the news media not understanding the importance and significance of events taking place in the insurance marketplace.

ConvergenceRI was not surprised by Andruszkiewicz’s “disappointment,” if that’s the right word.

Or, by the lack of comprehensive, in-depth coverage of health care by other news outlets in Rhode Island.

Or, by the apparent frustration voiced by CEOs such as Andruszkiewicz that the news media tended to chase its tail when covering health care in Rhode Island.

Without the kind of in-depth reporting and analysis that can be often found on a weekly basis in ConvergenceRI, connecting the flow of information across the current silos, the kind of engaged, informed conversation needed in a complex, changing marketplace does not occur.

Andruszkiewicz is a central player in many of the efforts now underway to reform the current health care delivery system: he’s one of the leaders of the statewide health compact organized by Neil Steinberg and Sen. Sheldon Whitehouse to move toward a system of global payments and away from the fee-for-service business model by 2019.

Andruszkiewicz is also a strong supporter of the patient-centered medical home initiative now known as the Care Transformation Collaborative, which has created an all-payer framework that serves about one-third of all Rhode Islanders in the delivery of primary care.

Andruszkiewicz is a key member of the 27-person Working Group to “Reinvent” Medicaid.

Andruszkiewicz is also identified as a key community player in the development of strategies and decision-making under the $20 million State Innovation Model grant.

And, Andruszkiewicz is also a participant in the ongoing Health Care Planning and Accountability Advisory Council Health Advisory Council that has two major studies coming to completion – one detailing the total costs of Rhode Island’s health care delivery system, the other on the costs of the state’s behavioral and mental health system.

Andruszkiewicz has also entered into a strategic alliance with Care New England to develop shared approaches to future health care delivery initiatives, including one now underway with Continuum, the for-profit arm of The Providence Center, to develop wrap around services in the behavioral health arena through HealthPath.

No wonder Andruszkiewicz talked recently with Elizabeth Roberts, the secretary of R.I. Executive Office of Health and Human Services, about the need to consolidate the efforts around such studies and groups, according to Roberts.

Reforming the health care delivery system has become a second full time job, in addition to running the state’s largest commercial health insurer.

And, with such big changes underway in Rhode Island’s health care delivery system and its insurance market, such attention is required.

Big changes underway
Tufts Health Plan, after years of playing a cat-and-mouse game about entering the Rhode Island marketplace, saying it would, and then it wouldn’t, enter the market through HealthSourceRI, dramatically changed its strategy.

In an April 1 news release, Tufts announced a new product, Lifespan Premier Choice, what it claimed was a “first-of-its kind” tiered network health plan, offering Rhode Island companies the opportunity to enroll in a health plan beginning July 1, where the lowest priced tier would be all providers within the Lifespan health system.

Lifespan has been struggling with its self-insured health plan a number of years, seeking to force its employees to pay more for services delivered outside the Lifespan network, through higher co-pays. That effort ran into stiff opposition from employees and union members. [See links below to ConvergenceRI stories.]

Now, Tufts and Lifespan have joined forces in a way that markets Lifespan’s network – what was described as “Rhode Island’s largest and most comprehensive health system,” with Tufts Health Plan, which was described as the “number one-ranked” health insurance plan in the country,” with an asterisk.

“Lifespan Premier Choice is truly a new and unique plan design that helps employers control their health care costs while providing their employees and their families access to great quality care and the lowest cost-sharing when they utilize the Lifespan health system," said James Roosevelt Jr., CEO of Tufts Health Plan, in a news release. “We are pleased to work with Lifespan to develop this innovative plan.”

What Roosevelt didn’t say – and what no one else from the news media questioned him about – is this: how is the newly announced Lifespan plan different from Tuft’s efforts to launch a very similar tiered health plan product with Steward Health Care in Massachusetts?

What were the numbers of people enrolled in the Steward plan? How was it comparable to what is being rolled out with Lifespan? What were the lessons learned from the Steward experience?

Up until now, Steward has been very tight-lipped about sharing any information or data with ConvergenceRI about the tiered plan introduced by Tufts Health Plan and itself. Repeated attempts to obtain answers had been rebuffed in the past.

Similarly, at Tufts Health Plan, attempts to obtain actual numbers of enrolled members in the tiered plan had been met with continued resistance over the past few years, despite persistent asking of questions.

Beyond the new plan, what are the reasons why Tufts and Lifespan chose not to offer the new health insurance tiered network on the health insurance exchange in Rhode Island? Was it because that under HealthSourceRI, the charges under the plan would be more transparent when compared with other plans?

What it means for the marketplace?
In response to the creating news by press release strategy, ConvergenceRI followed up, asking Lifespan a series of questions, including: “How does the new arrangement with Tufts change the way that your self-insured plan is administered, which as I understand it, is through Blue Cross & Blue Shield of Rhode Island?

Are Lifespan employees eligible to participate in the new tiered plan? What is the target number of people that Tufts and Lifespan seek to enroll in the new health plan?

And, did Lifespan do any investigation into the previous efforts by Tufts to launch a similar program with Steward Health Care in Massachusetts.

Lifespan’s spokeswoman Gail Carvelli responded by saying, in an e-mail: “I did want to point out that Lifespan Premier Choice is being offered by Tufts Health Plan.”

Lifespan, she continued, “is not offering the plan. It’s only being offered to Rhode Island employers, and that will start on July 1, 2015,” Carvelli wrote. “It doesn’t impact our current employee plan.”

ConvergenceRI also followed up with Stacy Paterno at Blue Cross & Blue Shield of Rhode Island, asking how the new collaborative plan launched by Lifespan and Tufts might affect Blue Cross’s role as the administrator of Lifespan’s self-insured plan.

Paterno responded: “Thanks, Richard. I am sure you understand that we cannot comment on this. We do not discuss any details regarding customer relationships.” She continued: “You would need to ask Lifespan that question.”

ConvergenceRI also asked a series of questions to Sonya Hagopian, communications spokeswoman at Tufts Health Plans. They included:

•  What are the enrollment numbers for Tufts’ similar tiered plan with Steward Health Care?

•   How has the experience with Steward Health Care influenced the design of the current Lifespan plan?

•   The news articles written about the new plan suggested that the insurance plan will not be offered on the HealthSourceRI exchange. Why not?

Tufts Health Plan did not respond.

Finally, ConvergenceRI reached out to Steward Health Plan, once again, to try to uncover the results of the previous tiered health plan that Tufts had offered with Steward in Massachusetts.

That response is being developed.

Perspective from HealthSourceRI
Anya Rader Wallack, the director of HealthSourceRI, responded to questions about Tufts delayed entrance into the Rhode Island health insurance exchange marketplace in a telephone interview.

“Tufts Health Plan will not be coming in next year,” Wallack said. “But they said they are still interested in doing so in the future.”

Wallack said that Tufts had told her that the emphasis would be on launching the new Lifespan product, which would only be offered to companies, and on making that a successful venture.

Tufts, Wallack continued, had told her that the health insurer was focused very hard on helping Massachusetts “right the ship” in terms of their state exchange, as well as with new innovative products in New Hampshire.

“Jumping in with us next year was a stretch for them,” she said. Tufts said they were still interested in coming in, adding: “Tufts wants to see what happens with the other carriers, the other carriers are the canaries in the coal mine.”


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