In 2011, Neighborhood Health Plan of Rhode Island generated net income of about $11 million, after all medical and administration expenses were met. More than 40 percent – $5.1 million – of that profit came directly from savings as a result of patient medical-expense avoidance achieved by Blackstone Valley Community Health Center, according to Blackstone Valley’s calculations.
The key to their ability to curb costs while delivering high-quality care, according to Heather Budd, chief operating officer of the Pawtucket health center, is its integration of patient data at the point of care.
“We are using the integration of data to build the kind of relationships our staff needs to have with patients to make the difference where they can motivate a patient to change behavior,” Budd said. “That’s not something that happens in the electrons of the product, it happens in the relationship between people on the ground.”
While Medicaid premiums in Rhode Island were about $300 per member, per month in the fourth quarter of 2011, Blackstone Valley’s patient expenses were under $190 per member per month for that quarter.
“What Blackstone Valley is doing is incredibly remarkable,” said Brenda Whittle, director of external affairs and marketing at Neighborhood Health Plan. “It’s amazing.”
The health insurer serves more than 92,000 members through its network of primary-care providers, including all nine of Rhode Island’s community health centers. Neighborhood’s membership represents about 66 percent of all Medicaid managed-care participants in Rhode Island.
At the same time Blackstone Valley achieved such significant cost avoidance in patient medical expenses, the community health center also maintained and improved its outcomes in quality measures, such as for diabetic patients.
More than just an investment in technology, Blackstone Valley has also made an investment in its human capital, too, redesigning the delivery of health care services around a team “huddle” approach within its patient-centered medical home model.
“We figured out that we needed to add support staff in key roles in order to enable this to happen and to preserve that artfulness of diagnostics and relationship-building,” Budd said.
Blackstone Valley created a new role, the “administrative medical assistant,” or AMA, to quarterback the new delivery service model and be responsible for running the health IT tools and the flow of communications between patients and providers.