PROVIDENCE – The fourth definition of mouthpiece, according to my very worn hard copy of the American College Dictionary, following definitions of an object put into a musical instrument such as a trumpet, and the part of a bit or bridle that passes through the mouth of a horse, is: a person, a newspaper or the like that voices the sentiments, decisions, etc., of another or others; a spokesman.

ConvergenceRI had been spurred to look up the definition following the publication on March 20 of the contents of a news release by Neighborhood Health Plan of Rhode Island as a news story by both The Providence Business News and GoLocalProv, without any apparent critical reporting or analysis.

Here’s how the story began in the online PBN Daily Edition newsletter, slugged as the “Top Story,” under the headline, “Neighborhood Health says Integrated Care Initiative results in fewer long-term nursing home placements.” It ran under the byline, PBN Staff.

SMITHFIELD – Close to 500 Rhode Islanders avoided long-term admission to a nursing home and another 150 Rhode Islanders were transitioned out of such placements as a result of Neighborhood Health Plan of Rhode Island’s work in support of the state’s Integrated Care Initiative, the insurer said Monday.

Neighborhood said it analyzed approximately three years’ worth of state and internal data to come up with its findings.

The ICI, Neighborhood explained in a news release, is part of a state effort to help people continue to live in the community with appropriate supports instead of being placed in a skilled nursing facility.

“People who are older or disabled are often eager to remain in their homes and communities for as long as possible, and Neighborhood Health Plan of Rhode Island helps make that happen through our managed care programs,” Peter Marino, Neighborhood’s president and CEO, said in a statement. “We know that Rhode Island’s seniors have the potential to be more physically and emotionally well when they are able to live independently. We also know that helping them do so can provide substantial cost savings to our state’s taxpayers.”

By publishing the contents of a news release as a news story, without adding any context, critical analysis or reporting, does that fit the definition of a “mouthpiece?”

The missing context
The missing context to the story was that in her FY 2018 proposed budget, now under review by the R.I. General Assembly, Gov. Gina Raimondo had recommended a $12.2 million reduction in administrative fees paid to Neighborhood Health Plan of Rhode Island because of concerns about the lack of outcomes achieved by the first phase of the Integrated Care Initiative, originally known as Rhody Health Options.

The original budget recommendation from the R.I. Executive Office of Health and Human Services had called for a $35 million reduction in administrative fees and the elimination of the Rhody Health Options program. [See link to ConvergenceRI story below.]

The reason given in the original budget recommendation: “The significant investments by Medicaid into the Integrated Care Initiative to date have had limited impact on reducing nursing home use.”

To leave out the context – by failing to mention the fact that Neighborhood Health Plan is facing a shave and a haircut of some $12.2 million in administrative fees in the FY 2018 budget – appears to be both an error of omission and an error of commission when it comes to reporting the news.

Saving money?
In the news story, the president and CEO of Neighborhood Health Plan is quoted, claiming: “We know that Rhode Island’s seniors have the potential to be more physically and emotionally well when they are able to live independently. We also know that helping them do so can provide substantial cost savings to our state’s taxpayers.”

The key phrase is “substantial cost savings.” What are those costs savings? To answer that, you have to know how much Neighborhood Health Plan has been paid in administrative fees since its launch in 2013.

It was one of a number of questions that ConvergenceRI asked the R.I. Executive Office of Health and Human Services.

Here are the numbers, published for the first time:

• For the fiscal spending year ending on June 30, 2014: $7,859,948

• For fiscal spending year ending on June 30, 2015: $21,267,447

• For fiscal spending year ending on June 30, 2016: $25,621,741

• For fiscal spending year ending on June 30, 2017 [estimated]: $29,288,806

The total of administrative fees for the last four fiscal years paid to Neighborhood Health Plan for Rhody Health Options: $84,037,942.

The question remains: What were the outcomes of the first phase of the Integrated Care Initiative in direct comparison to the money spent on administrative fees? Translated, can you calculate what was the cost per person of transition outcomes?

Follow the money
When Rhody Health Options was first launched in the fall of 2013, its proponents projected that the program would achieve as many as 3,000 transitions from nursing homes back into the community.

Despite the hoopla and hype, Rhody Health Options never achieved anywhere near that number.

According to the recent Neighborhood Health Plan news release, based upon the self-review and analysis of its own data, over a three-year period, “Neighborhood transitioned 147 [managed Medicaid] members from a nursing facility into independent living with community-based services.

What R.I. EOHHS found in its own analysis of the numbers was revealing:

“The FY 2018 proposed budget looks at one piece of the demonstration project – patients who reside in nursing homes over 90 days,” according to Sophie O’Connell, spokeswoman with R.I. EOHHS, in explaining the proposed reduction in administrative fees to Neighborhood Health Plan.The total administrative fees cover all of the program, she said.

The budget, O’Connell continued, proposes to transfer care management for those patients out of Managed Care, and to manage their care through another means [for example, through Medicaid’s nursing home transition team].

“Data from calendar year 2016 suggest that patients who are in a nursing home for more than 90 days have a low transition rate,” O’Connell said. “Specifically, R.I. Medicaid data from the Money Follows the Person transition program shows we were able to transfer about 1.7 percent of Neighborhood Health Plan [managed Medicaid] members from a nursing home following a 90-day stay.”

Translated, once a determination of care has been made for patients, the likelihood of managed Medicaid patients being transferred from nursing homes back to the community was very limited. That’s exactly what critics of the program had been saying since its launch in 2013.

The problem with O’Connell’s explanation regarding administrative payments to Neighborhood Health Plan’s outcomes is that it appears to mix the results from two different programs. The “money follows the person” transition program had been implemented, in collaboration with skilled nursing facilities, before Rhody Health Options was ever launched. That program had begun in 2009 under the Global Medicaid waiver, according to numerous sources.

As reported by ConvergenceRI in its Oct. 31, 2016, edition:

• In 2015, the total number of transitions achieved under the direct auspices of Neighborhood Health Plan [and not under other pre-existing programs] was 36, according to the state’s public records. That is correct: 36 transitions.

• Even more damning, the total number of transitions from nursing facilities back to the community [turned out to be] actually lower than the transitions achieved when compared with previous programs underway before Neighborhood Health Plan became involved, according to state’s public records.

It’s difficult to make comparisons between calendar year outcomes and fiscal spending year amounts. Still, the given that the fact that fiscal year spending increased in 2016, compared to 2015, the financial calculation comparing costs vs. transitions appears to have some validity, absent a calendar year breakdown of administrative costs.

In calendar year 2015, Rhody Health Options, under the administration of Neighborhood Health Plan, achieved 36 transitions under the program. When divided by the cost of $21,267,447 in administrative fees paid to Neighborhood Health Plan in spending year 2015, it equals a cost of about $590,000 per transition.

How does that translate into cost savings for the state?

Who’s responsible for crunching the numbers?
In the news story based upon the news release by Neighborhood Health Plan of Rhode Island, it said that the numbers crunching was conducted by the health insurer – without any independent or third party corroboration, including by the R.I. Medicaid office or by the R.I. General Assembly.

As reported by The Providence Business News: Neighborhood said it analyzed approximately three years’ worth of state and internal data to come up with its findings.

O’Connell shined some additional light on the topic in her response to questions from ConvergenceRI.

“We do not have a separate analysis on the Medicaid side that could be compared in an apples-to-apples way with the data from Neighborhood,” O’Connell said. “Specific questions about the data cited by Neighborhood are best directed to Neighborhood.”

Further, O’Connell continued, “EOHHS is not aware of reports the legislature has produced on this topic.”

An emotional leap of faith, swallowed
Talk about success in managing the messaging. In the news release by Neighborhood Health Plan, the suggestion that the health insurer was responsible for fewer long-term care placements in nursing homes was included in the headline for the online story in PBN: “Neighborhood Health says Integrated Care Initiative results in fewer long-term nursing home placements.”

The problem, of course, was there was no critical reporting to check the facts behind the claim asserted by Neighborhood Health Plan.

The actual numbers for Rhode Island tell a different story; nursing home occupancy rates have been declining since 2001, as they have been nationally.

Further, between December 2013 and December 2016, nursing home occupancy rates declined from 92 percent to 90 percent, while U.S. occupancy rates declined from 83 percent to 81 percent over that same time period.

How much of that decline in occupancy can be attributed directly to Neighborhood Health Plan of Rhode Island, which reflects a national trend? Good question; one that has yet to answered.

In its news release, as quoted in the PBN story, Neighborhood Health Plan also claimed that since 2013, the health insurer had diverted some 495 Rhode Islanders from long-term placements in skilled nursing facilities, “helping them obtain and maintain independent living arrangements with needed supports and services.” Then came the caveat: “Those Rhode Islanders were initially sent to nursing facilities for short-term placements.”

How are diversions being defined? How many of the diversions followed rehabilitation stays following surgery? How many of the diversions were done in collaboration with other programs, and how many were the direct responsibility of Neighborhood Health Plan? All good questions?

One more question. When will Rep. Patricia Serpa, chair of the R.I. House Oversight Committee, begin to look into the budget numbers around the administrative fees paid to Neighborhood Health Plan of Rhode Island for Rhody Health Options?

The total amount is more than $84 million, larger than the $75 million in payments promised to 38 Studios.