Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Private Payers News

Tufts Health Plan Sees Opportunities as New RI Medicaid Option

Rhode Island is adding its first new Medicaid option in seven years as Tufts Health Plan begins operations in the state.

RI welcome new medicaid option

Source: Thinkstock

By Jesse Migneault

- Rhode Island will add Tufts Health Plan (THP) as its first new Medicaid option in seven years, according to the Rhode Island Executive Office of Health & Human Services (EOHHS).  The new program, RITogether, will allow Medicaid beneficiaries to integrate primary and behavioral healthcare with THP’s extensive network of providers and services. 

Rhode Island’s Medicaid population is currently served by two options, Rite Carea and Rhody Health partners.

"We are ecstatic that Rhode Islanders receiving Medicaid will now have another great option for administering their health care benefits," said Patrick Tigue, Rhode Island's Medicaid director. "Tufts Health Plan has an outstanding reputation and we are happy they will partner with us and expand in our state."

Since 2009, THP has offered commercial individual and employer health insurance in Rhode Island.  RITogether is currently in a five year contract with the state, with options to renew.

RITogether brings a holistic integrated approach to Medicaid with a focus on primary and behavioral health through THP’s member-focused care management programs. 

“In Rhode Island, the governor has put a major emphasis or reinventing Medicaid with a large focus on paying for value not volume,” said Helene Forte, VP of Care Management at THP to HealthPayerIntelligence.com.  Forte is leading the introduction of RITogether.  “We’re instead focusing on integration, improving quality of care and value to Rhode Island constituents at large.”

“We are very holistic in our approach,” added Forte. “We focus not on just physical but also mental and behavioral as well as social determinants of care.  We offer a truly integrated approach getting members connected with appropriate social supports they need, if its housing or food, or fuel for home heating.”

According to Forte the goal for RITogether is a proactive involvement with the member. 

“The closer the care can be to the member the better aware of other issues going on with that individual,” said Forte.  “We can adjust their treatment plan appropriately focusing not just on complex but also population health and wellness issues, making sure we are addressing all the needs of the member”

For THP, the challenges of moving into a new Medicaid market are two-fold. “We  need to staff up for the new business we will implementing,” said Forte.  “We also need to make sure that all of our policies and protocols are in line with local rules and regulations.”

“Staffing up without being certain of how many members we are working with is a challenge,” admitted Forte. “It’s hard to predict the number of enrollees even with outreach. We hope to get some good traction in the first year and then hope to expand.”

Rhode Island currently does not have a set open enrollment period.   That means despite notifications and outreach, if a current member does not actively change plans they will automatically be re-enrolled in their current plan.  The state is considering an annual period of open enrollment but no decision has been reached yet, said Forte. 

RITogether will be available to eligible new members starting June 1st.  From June to the end of the year it will be available to existing Medicaid members who will be able to change plans without cause. 

THP currently serves over 1.1 million members in Massachusetts, Rhode Island and New Hampshire through employer-sponsored plans; Medicare; Medicaid and Marketplace plans. 

The introduction of RITogether will also bring jobs, according to Forte.  Already 30-40 positions are being filled in the Providence area.  In addition to a network of care managers and other clinical staff there will be new opportunities for providers and customer service representatives. The company is also making plans to work with local community groups and colleges to establish job training programs.

X

Sign up for our free newsletter:

Our privacy policy


no, thanks

Continue to site...