Updated January 25 at 4:55pm
health insurance

R.I. health insurance CEOs share future strategies

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CRANSTON – More than 125 representatives of small businesses filled the Shriners’ Imperial Room on Tuesday morning to hear the three presidents and CEOs of the state’s commercial health insurers – Peter Andruszkiewicz of Blue Cross & Blue Shield of Rhode Island, Stephen J. Farrell of UnitedHealthcare of New England and James Roosevelt Jr., of Tufts Health Plan of Rhode Island – answer questions about their efforts to reduce high costs and increase wellness benefits in health plans.

The session was conducted by the ad hoc Health Insurance Small Employer Taskforce under the direction of R.I. Health Commissioner Christopher F. Koller, who described the gathering as an effort to give voice to the concerns of those “those paying the most and heard the least.”

Much of the session, however, featured the three health insurer leaders being questioned by former TV news anchor Dyana Koelsch (and current host of WSBE-TV PBS 36 show “A Lively Experiment”), who sought to have Roosevelt, Farrell and Andruszkiewicz articulate policy differences in their health plan strategies.

Roosevelt, calling the rising cost of health care “unsustainable,” said Tufts Health Plan was pursuing a “coordinated care” approach, moving toward a global payment model that engaged providers in terms of reducing volume while increasing wellness and outcomes.

In Massachusetts, Roosevelt continued, Tufts has introduced a number of tiered and limited network plans, with an effort to increase transparency of costs to enable consumers to make choices based on full information. No such plans are currently being offered in the Rhode Island market, according to Roosevelt.

Andruszkiewicz positioned Blue Cross’s efforts to move away from paying for volume-based to value-based delivery of health care services. “True health care reform will not occur until you have payment reform,” he said. In Rhode Island, he said that “cost-sharing can be an effective tool” to achieving value-based benefits. Blue Cross is making major investments in supporting patient-centered medical homes and primary care providers to be at the center of health care delivery, according to Andruszkiewicz. In its contracts with Rhode Island hospitals in 2012, about 20 percent of reimbursement costs are based on quality outcomes and the lack of hospital readmissions.

Farrell, jokingly asking his competitors to cover their ears “so I can share my plans,” described UnitedHealthcare’s approach to support “value-based, evidence-based medicine” that pays for performance. Farrell cited his company’s efforts to develop strategies to address the epidemic in obesity, citing reports that 36 percent of Rhode Island’s population is diabetic or pre-diabetic. United’s new plan designs, he said, seek to better align companies, caregivers and customers, so that cost-savings are achieved by increasing compliance, by efforts at better education, and by access to providers who produce the best outcomes.

In the little time remaining for questions from the audience, Ken Block, former Moderate Party candidate for governor and owner of a small IT company, described his frustration in trying to manage high-deductible health insurance plans. Block complained that the information he got was “indecipherable,” making it impossible for him to manage costs better, despite his prowess in number crunching.

Andruszkiewicz, Farrell and Roosevelt all agreed that more transparency was needed.

Roosevelt said that he, too, had had a high deductible policy for his wife and family, but that also found it too “complex,” saying that this was not the way they wanted to spend their lives.

The next meeting of the Health Insurance Small Employer Task Force is scheduled for Tuesday, March 27, and it will be focused on providers. Participants include: Dennis Keefe, president and CEO, Care New England; Dr. Al Kurose, president and CEO, Coastal Medical; Dr. Gary Bubly, director of The Miriam Hospital’s Emergency Department and the University Emergency Medicine Foundation; and Dr. Peter S. Margolis, president of University Gastroenterology. The time and the place have not yet been determined, but additional information will be available at RITaskforce.com.

Christopher, Koller, representatives, Stephen J. Farrell, UnitedHealthcare of New England, Roosevelt

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