Deal Flow

Money talks

$10 million in impact investing, $8 million in savings for the Integra ACO, and a Trump jump in insurance rates of 18-20 percent

Photo by Richard Asinof

Neil Steinberg, president and CEO of The Rhode Island Foundation.

By Richard Asinof
Posted 10/30/17
The Rhode Island Foundation continues to build its leadership portfolio through a new program of impact investing, with plans to invest some $10 million from its principal in the first year. Care New England’s Integra accountable care organization achieved $8.3 million in savings in 2016, welcome news for the financially strapped health system, a vote of confidence in its strategy to invest in accountable care. President Trump’s decision to end Cost Sharing Reduction Payments to insurers resulted in a 18-20 percent hike in insurance premiums for the individual market segment in Rhode Island.
What other entities beyond The Rhode Island Foundation are willing to invest some of their investment portfolio in impact investing activities in Rhode Island? How will Partners Healthcare view the positive results of Care New England’s success in achieving significant cost savings through its accountable care organization? How will proposed tax cuts under the Trump tax reform plan jeopardize future spending on Medicare and Medicaid?
The potential buyout of Aetna by CVS Health, which would create one of the largest corporations in America, may make it more difficult for consumers, insurers and businesses to negotiate better drug prices moving forward. CVS would become the pharmacy, the health clinic, the drug infusion site, the pharmacy benefit manager as well as the health insurer. It may also precipitate CVS moving from its existing headquarters in Woonsocket. Imagine the kind of incentive packages that would be offered CVS to entice them to move.

PROVIDENCE – The Rhode Island Foundation continues to be one of the leading investors in public policy and social change in the state, a position reinforced with the announcement of a new program of “impact investing,” with plans to invest up to $10 million in the first year.

The investments, which can be either done as loans at low interest rates or as stock purchases, involves using money from the existing principal in The Rhode Island Foundation’s portfolio, which is currently about $870 million, according to Neil Steinberg, the president and CEO of the Foundation.

Two first investments have already been made: a $1 million bridge loan to Rhode Island Public Radio to support the purchase and relocation of the 89.3 FM signal transmitter; and a $300,000 purchase of preferred stock in the Urban Greens Food Co-op, to help leverage additional investment in plans to open an 8,000-square-foot, community owned grocery store in the West End of Providence, a federally recognized food desert.

Unlike its grants to nonprofit groups in Rhode Island, which in 2016 were a record $45 million to organizations addressing the state’s most pressing needs, the new kind of impact investing can involve both nonprofit and for-profit companies, according to Steinberg.

“Impact investing is not new,” Steinberg told ConvergenceRI. “Private foundations have done it for a long time. In the past, the Rhode Island Foundation did it sporadically. We were the original funders [through a loan] of the Neighborhood Health Plan of Rhode Island.”

The new initiative, Steinberg continued, “is above and beyond our normal grant-making.”

The two criteria for making investments are social impact and financial return, Steinberg said. “Social impact is not a scoring rubric, it’s about contributing to the social good beyond the just for profit motive.”

With a current return on investments in the Foundation portfolio at about 7.5-8.5 percent, Steinberg said, the impact investments will look for a more modest investment return.

The Rhode Island Foundation also announced its 7th annual Carter Fellowships for Entrepreneurial Innovation, offering seed grants of up to $200,000 over four years to test and implement innovative ideas that could dramatically improve an area of life in Rhode Island.

$8.3 million in savings from accountable care
Care New England has not had a lot to crow about in recent weeks, but the news last week about the savings achieved by its accountable care organization, Integra, was very good.

Care New England’s Integra Community Care Network, a health system-wide accountable care model, achieved $8.3 million in savings in 2016, according to the Centers for Medicare and Medicaid Services.

As a result, a portion of the savings, some $3.85 million, will be shared with primary care practices participating in Integra as well as reinvested in the organization’s infrastructure.

Under the model, Integra provides comprehensive care coordination for primary care, specialists, care managers and skilled nursing facilities, according to Dr. Al Puerini, the chair of Integra’s board of directors.

Integra is the largest Accountable Care Organization in Rhode Island, covering approximately 120,000 lives through a provider network of more than 225 primary care providers and more than 430 specialists, according to the news release. [See link to ConvergenceRI story below, “Investing in the future of accountable care.”]

Questions about how the savings of some $4.45 million will be applied to Care New England’s finances, whether it would be for the fiscal year that ended on Sept. 30, or for the upcoming fiscal year, were not answered by Care New England. Neither were questions about how the $3.85 million in savings would be divvied up among the primary care practices and other members of the Integra team.

Calling it a Trump tax
In response to the decision by President Donald Trump to end Cost Sharing Reduction payments to insurers that supported reduced out-of-pocket expenses for low-income consumers, the R.I. Office of the Health Insurance Commissioner approved new individual market rates for 2018 of some 18-20 percent, in what it called a “Trump Tax.”

In explaining her decision to increase the rates, R.I. Health Insurance Commissioner Marie Ganim said: “I want to make it very clear that the President’s decision to end these payments has already created unnecessary turmoil and threatened the stability of our health insurance market.”



Cost Sharing Reduction payments had been included as part of the Affordable Care Act to help insurers offer plans with reduced co-pays and deductibles – known as “cost-sharing” – to individuals and families who earn between 138 percent and 250 percent of the federal poverty level, according to Ganim.

Although the federal Cost Sharing Reduction payments have stopped, insurers are still required by the Affordable Care Act to offer plans with reduced cost sharing to those who qualify.

Health insurance rates for 2018 had previously been approved by OHIC in August, but those rates had been calculated based on continued CSR payments.

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