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LeddyView Graph # 1 OUTLINE Background - RIte Care Rhode Island’s Title XXI Plans RIte Care Benefit Package Experience Impact on Health Care Access, Utilization,

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Presentation on theme: "LeddyView Graph # 1 OUTLINE Background - RIte Care Rhode Island’s Title XXI Plans RIte Care Benefit Package Experience Impact on Health Care Access, Utilization,"— Presentation transcript:

1 LeddyView Graph # 1 OUTLINE Background - RIte Care Rhode Island’s Title XXI Plans RIte Care Benefit Package Experience Impact on Health Care Access, Utilization, and Health Status Monitoring Strategies

2 LeddyView Graph # 2 Begun in 1994 1115 Waiver Enroll TANF Families Into Their Choice of Four Health Plans Incremental Strategy to Provide Coverage to the Uninsured BACKGROUND - RITE CARE

3 LeddyView Graph # 3 1994 - Provided RIte Care Coverage to Children to Age 6 and Pregnant Women Up to 250 Percent of FPL 1996 - Expanded RIte Care Coverage to Children to Age 8 Up to 250 Percent of FPL 1997 - Expanded RIte Care Coverage to Children to Age 18 Up to 250 Percent of FPL 1998 - Bill to Expand RIte Care Coverage to Parents Up to 185 Percent of FPL RHODE ISLAND’S COVERAGE OF THE UNINSURED

4 LeddyView Graph # 4 75,000 are Enrolled 52,000 of Whom are Children Under 18 Covers 1/3 (4,000) of the State's Births Annually 91 Percent of All RIte Care Enrollees Choose Their Own Health Plan Through RIte Care, Virtually all Rhode Island Children Have Access to Comprehensive Health Insurance RITE CARE ENROLLMENT

5 LeddyView Graph # 5 New Streamlined Mail-In Application and Significant Investment in Outreach Will Help Us Enroll the Remaining 15,000 Uninsured Children Who Are Eligible But Not Yet Enrolled RITE CARE ENROLLMENT (cont.)

6 LeddyView Graph # 6 Improve Access Assure Quality Results: Improved Health Status - Decrease LBW - Increase Prenatal Care - Improve Immunization Rates - Decrease Lead Poisoning - Lengthen Interpregnancy Interval - Decrease Preventable Hospitalization RHODE ISLAND’S GOALS UNDER RITE CARE

7 LeddyView Graph # 7 Rhode Island has Already Covered the Title XXI Population Experience with Benefits, Program Evaluation, and Monitoring Strategies Rhode Island's CHIP Plan was Approved in May, Allowing Title XXI Coverage for Our Latest RIte Care Expansion Group: Children ages 8 - 18 Up to 250 Percent of FPL RHODE ISLAND’S TITLE XXI PLANS

8 LeddyView Graph # 8 Title XXI Public Process Has Resulted in a Recommendation to the Governor to Seek Approval Under Title XXI to Serve Families: - Uninsured Parents of RIte Care Children - Uninsured Older Siblings - Foster Parents RHODE ISLAND’S TITLE XXI PLANS (cont.)

9 LeddyView Graph # 9 Transportation - RIPTA Translation Services Multilingual and Multicultural Provider Network and Member Services RITE CARE IS MORE THAN A STANDARD COMMERCIAL PRODUCT

10 LeddyView Graph # 10 Unlimited Mental Health and Substance Abuse Services Early Intervention School-Based Clinics Consumer Advisory Council RITE CARE IS MORE THAN A STANDARD COMMERCIAL PRODUCT (cont.)

11 LeddyView Graph # 11 New Definition “--‘Medical Necessity’ or ‘Medically Necessary Service’ means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health related condition including services necessary to prevent a decremental change in either medical or mental health status. Medically necessary services must be provided in the most cost effective and appropriate setting and shall not be provided solely for the convenience of the member or service provider” MEDICAL NECESSITY

12 LeddyView Graph # 12 Goal: Break the Cycle of Lead Poisoning Through Education and Environmental Intervention Beginning July 1998 Intensive Case Management, Including Assistance with Relocation or Finding Temporary Housing, as Needed Family Education on Establishing and Maintaining a Lead-Safe Environment Referrals to and Coordination with Other Health and Social Service Programs Replacement of Windows to Prevent Recurrence of Lead Poisoning RHODE ISLAND’S TITLE XXI PLANS (cont.)

13 LeddyView Graph # 13 Beginning January 1999 Professional Nursing Case Management and Home Visitation Mother Will be Enrolled as Soon as Pregnancy is Identified; Mother and Child Remain in Program Until the Child is Two, with Appropriate Linkages to Other Resources Home Visitations Will be Frequent, on the Order of Twice Per Month Intervention is Targeted to Low-Income, First-Time Teen Mothers, Based on Research by Dr. David Olds RITE BEGINNINGS

14 LeddyView Graph # 14 Focus on Parenting Skills, Child Development, Self- Sufficiency, Problems Solving Skills, Health Care Compliance, Enhancing Personal and Community Network Outcome Measures to Include: - Increased mother and child health care compliance - Decreased maternal smoking, alcohol and substance abuse - Increased interbirth intervals - Reduction in child abuse and neglect - Improved maternal education and employment status RITE BEGINNINGS (cont.)

15 LeddyView Graph # 15 Improved Access to Primary Care Doubled Primary Care Physician Participation Doubled Physician Visits From Two Per Year to Five Per Year Decreased Emergency Room Visits and Hospital Utilization by One Third RITE CARE’S IMPACT ON HEALTH CARE ACCESS, UTILIZATION AND HEALTH STATUS

16 LeddyView Graph # 16 Positive Impact on Maternal Health Decreased the Number of Women on Medicaid With Short Intervals (Less Than 18 Months) Between Births From 42 in 1993 to 28 Percent in 1996, Almost Completely Closing the Gap Between Medicaid and Commercially Insured Women RITE CARE RESULTS

17 LeddyView Graph # 17 % OF WOMEN WITH SHORT INTERVAL BETWEEN BIRTHS (<18 MONTHS) BY INSURANCE STATUS 1993-1996

18 LeddyView Graph # 18 Improved Prenatal Care Increased the Number of Pregnant Women Entering Prenatal Care in the First Trimester Significantly From 76% in 1993 to 81% in 1996 RITE CARE RESULTS

19 LeddyView Graph # 19 % BEGAN PRENATAL CARE IN 1ST TRIMESTER BY INSURANCE STATUS 1993-1996

20 LeddyView Graph # 20 RITE CARE RESULTS Improved Prenatal Care Adequate Prenatal Care Also Increased Significantly From 55% in 1993 to 69% in 1996

21 LeddyView Graph # 21 % OF WOMEN WHO RECEIVED ADEQUATE/ADEQUATE PLUS CARE BY INSURANCE STATUS 1993-1996

22 LeddyView Graph # 22 Positive Impact on Maternal Health The Percentage of Pregnant Women on Medicaid Who Smoked During Pregnancy Decreased Significantly From 33% in 1993 to 27% in 1996 RITE CARE RESULTS

23 LeddyView Graph # 23 % OF PREGNANT WOMEN WHO REPORT SMOKE CIGARETTES BY INSURANCE STATUS 1993-1996

24 LeddyView Graph # 24 RITE CARE RESULTS

25 LeddyView Graph # 25 Overall, 97% of the 1,344 Respondents (43% Response Rate) to a December 1997 RIte Care Member Satisfaction Survey were "Very Satisfied" or "Satisfied" with RIte Care; In 1996 it was 95% of the 1,009 Respondents (30% Response Rate) 95% of Respondents were "Satisfied" or "Very Satisfied" with Their Primary Care Physician 95% of Respondents were "Satisfied" or "Very Satisfied" with the Amount of Time Primary Care Physician Spent with Them EXCELLENT MEMBER SATISFACTION WITH RITE CARE

26 LeddyView Graph # 26 The Provision of Anticipatory Guidance by Primary Care Physicians was Reported to be High by Respondents, For Example: - 79% of adults responded that their primary care physician talked to them about smoking - Between 60% and 70% of adults responded that their primary care physician talked to them about alcohol/drug use, diet, exercise, stress, and safe sex - 51% of adults responded that their primary care physician talked to them about mental health EXCELLENT MEMBER SATISFACTION WITH RITE CARE (cont.)

27 LeddyView Graph # 27 PERCENT OF ADULT RITE CARE MEMBERS WHO SELF REPORT THAT THEIR PCP TALKED ABOUT PREVENTIVE CARE

28 LeddyView Graph # 28 Access Studies Four Focus Groups Each Year Annual Health Plan Comprehensive Site Visits Member Satisfaction Survey Utilization Data Analyses Focused Clinical Studies Financial Reviews Review and Analysis of Complaints and Grievance Data Special Studies RITE CARE HEALTH PLAN CONTRACT OVERSIGHT AND MONITORING ACTIVITIES

29 LeddyView Graph # 29 Provider Network Composition Covered Services Service Accessibility Standards Member Services Provider Services Marketing Grievance and Appeals Encounter Data Reporting Financial Performance HEALTH PLAN MONITORING

30 LeddyView Graph # 30 Quality Assurance - HCFA requirements - Chart audits to support EQRO review - Adherence to internal quality standards, e.g.: - first pre-natal visit - baseline physical for new members - annual physical - routine care for newborns HEALTH PLAN MONITORING (cont.)

31 LeddyView Graph # 31 RIte Care Members Now Appropriately Access a Full Continuum of Quality Health Care and Support Services Broader Coverage Does Not Mean Greater Costs Partnership Between State and Health Plans is Critical to Success CONCLUSION


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