We continue to believe that the only avenue to a sustainable, affordable, and simple healthcare system for our state is through collaboration—among providers of healthcare, state leadership, customers, and regulators. Simply put, it takes a team.
Blue Cross & Blue Shield of Rhode Island continues to believe that the only avenue to a sustainable, affordable, and simple healthcare system for our state is through collaboration—among providers of healthcare, state leadership, customers, and regulators. Simply put, it takes a team.
The power of that shared commitment was never more apparent than in 2015. Our five-year study of patient-centered medical homes (PCMHs), which take a team approach to primary care, showed improved health outcomes compared to standard primary care providers—and a savings of $30 million in healthcare costs. Our next generation of PCMHs, Advance Primary CareSM practices, delivered a patient-centered experience powered by shared data and driven by accountability for healthcare quality. We also continued to move toward paying providers for improved quality of care with new accountable care agreements. Rhode Island has never been better positioned for the future.
Equally important to us is simplifying the healthcare experience for our customers. Building on the overwhelming success of our innovative retail stores, we’ve continued to listen to our customers, who are savvy, on-the-go, and expect a service and support model that suits their mobile lifestyle. We’re connecting with them in more meaningful ways through seven-day-a-week customer service, a 24/7 Nurse Care Line, and enhanced mobile shopping capabilities. It’s not what customers expect from a health insurer, but we think they should.
While the forces of change will continue within the healthcare industry for many years to come, Rhode Island has established a strong blueprint and foundation to build upon, as evidenced by the collaborative accomplishments of 2015.
Expanding Choice and Convenience
Lincoln or Warwick. Weekday or weekend. Online or in person. Now it’s easier than ever to ask questions or find the right plan. Discover how healthcare became more convenient for our members in 2015.
At our retail stores—Warwick, Bristol, and our new Lincoln location—we served almost three times as many Rhode Islanders as we did last year. People came to shop, ask questions about their plan, receive health screenings, and attend free wellness classes.
The yoga instructor was wonderful. I felt more peaceful, stronger, and healthier after the class.
Serving Our Members 7 Days a Week
Questions about healthcare can’t always wait until Monday. That’s why we introduced weekend customer service hours on Saturdays and Sundays.
Making It Simple to Shop
Our improved shopping experience features a modern, intuitive, and mobile- and tablet-friendly design to make it easier for customers to compare and buy plans on bcbsri.com. Our new application uses plain language, offers helpful tips, and outlines the information needed to complete the process. For members who have questions, we are happy to help in person at our retail stores.
Peace of Mind—All in One Place
Our customers have long relied on us for their medical, dental, and vision coverage. We know there are other protections that are important to them, so we introduced a suite of new products in 2015. Now customers enjoy the convenience of having a simple, affordable array of solutions through BCBSRI.
We provide travel health insurance through GeoBlue* and have partnered with Indigo Insurance Services, a subsidiary of Blue Cross Blue Shield Massachusetts, to offer:
Accidental death & dismemberment
Short-term and long-term disability
*GeoBlue is the trade name for the international health insurance programs of Worldwide Insurance Services, an independent licensee of the Blue Cross and Blue Shield Association.
Looking Forward: Connecting with Members Through Personalized Mobile Messaging
Starting in 2016, members will be invited to connect with us through a secure and personalized communication channel. We’ll use text and mobile-friendly capabilities to help members make the most of their healthcare. Members will receive messages about:
Choosing a doctor
Having important preventive screenings and immunizations
Managing ongoing health issues, including reminders about missed tests
Taking advantage of health plan tools and benefits
Members can easily respond to our messages or get in touch with any questions.
Proving the Team Approach
In 2015, we generated impressive results from our partnerships with doctors and hospitals, demonstrating that better quality and lower costs go hand in hand. Take a look at those accomplishments—and how they benefited our members.
We’ve invested in team-based care models throughout the state to deliver on the triple aim of improving health, improving the patient experience, and lowering the cost of care. A five-year study of patient-centered medical homes shows a 250% return on that investment for adults with commercial (non-Medicare) health insurance. Our Advance Primary CareSM practices are the next generation of patient-centered medical homes and will continue to drive positive results.
Creating New Accountable Care Agreements
In 2015, we continued to move toward paying providers for quality and value of care instead of the volume of services delivered. Here are two of those value-based agreements.
Integra Community Care Network
To improve the patient experience and reduce emergency room use, Integra will provide 60,000 BCBSRI members with eight new primary care access centers open seven days a week. Integra and BCBSRI will also jointly fund a patient support hub to help coordinate all aspects of members’ care.
CharterCare Health Partners (CCHP)
Through nurse care managers, pharmacists, and case management services, CCHP will coordinate and enhance healthcare for 6,500 Medicare Advantage members who have physicians affiliated with Prospect Provider Group of Rhode Island.
Improving Health and Affordability with Pharmacist Visits
Pharmacists in doctors’ offices. Over the phone. Even in members’ homes. Our Medication Therapy Management (MTM) Program helps BlueCHiP for Medicare members and other eligible members to manage their medications and save money on their prescriptions—all at no additional cost to them.
Avoided in healthcare costs
Kenny Correia [pharmacist] has had a huge positive impact on our patients with diabetes. He provides diabetic teaching, makes dosage adjustments based on sugar readings, and sees patients in the office to check on their progress.
Offering a Free In-Home Visit to New Parents
Meeting the needs of a newborn can be challenging. That’s why we offer a free doula visit to members who give birth at Women & Infants Hospital. Doulas are specialists in the care and treatment of babies and new mothers. This program, launched in partnership with Care New England, is the first of its kind in Rhode Island.
Having a doula visit the week after Antonio was born gave us the opportunity to figure out what we didn’t know and get help on the things we weren’t confident about. She also pointed out the things that we were doing correctly, which helped build my confidence as a new mother.
Bringing Back the House Call
Through HouseCall by Blue, certain Medicare Advantage members struggling with complex medical needs are supported by a personal healthcare team, in addition to their primary care doctor. They can get extra help in the privacy of their home, either for scheduled appointments or 24/7 for urgent care.
Average HouseCall by Blue appointments
Looking Forward: Using Information for Better Patient Care
We recently introduced Blue Insights for Rhode IslandSM, a new data and analytics platform that offers a 360-degree view of patients’ preventive, chronic, and complex health needs. This tool allows providers to:
Identify gaps in care, such as unfilled prescriptions and missed tests
Track the progress of patients with chronic conditions
Send reminders or alerts to members for tests or follow-up appointments
Blue Insights helps providers and customers make informed decisions that have a real impact on the quality and affordability of healthcare.
Making data ‘smarter’ and actionable drives patient outcomes, improves their care experience, and lowers their costs.
Leading the Way Together
To make healthcare simple and affordable for all Rhode Islanders, we’re collaborating with innovators that know how to drive lasting change. Learn how we’re shaping the future together.
Our new strategic partnership with Dell Services allows us to leverage the scale of a global IT company with innovative technology platforms and significant process improvement capability so that we can focus on transforming our local healthcare system. The partnership will enable us to bring tremendous value to current and future employers, members, and providers.
Our partnership with Dell makes us a far more flexible and agile company, able to quickly pivot in response to changing needs. That’s a huge plus in the rapidly evolving healthcare industry. And it will translate into a much better experience for our customers.
Supporting Healthcare Innovators
In 2015, we joined forces with the Social Enterprise Greenhouse (SEG)—a nonprofit network that provides resources and services to do well and do good business—to create “Gathering for Good Works.” Together we provided access to SEG’s programs and training by offering scholarships to local nonprofits, like the Rhode Island Free Clinic and others, to help them think differently and potentially create programs that drive profits.
With BCBSRI at the table, the Social Enterprise Greenhouse has been able to expand our social entrepreneurs’ access to the business and community leaders who will allow their health and wellness ventures to flourish.
Looking Forward: Designing for the Real World
How do we know what a transformed healthcare system will look like? Or what the experience of members and providers and health insurers will be? We’re the first insurer to work with Rhode Island’s Business Innovation Factory to imagine, prototype, and test a new system in the real world, so we get it right in the real world.
2015 Financial Report
The company’s strong performance in 2015 resulted in a $29.7 million increase to reserves for the protection of our members.
In 2015, greater traction within our provider partnerships in managing claims trend and successful efforts to control administrative costs resulted in a $21.6 million gain on operations. That gain was offset by significant one-time events. However, as those events were reserve neutral, we added $29.7 million to our reserves.
Here is a detailed look at how the company performed in 2015 (in thousands of dollars).*
In 2015, we recorded $1,661,319 in premiums from members (individuals and employers).
We also earned $10,561 in investment income.
From this total income, $1,388,431 was used for medical and dental claims for our members. This amount accounted for 83.6% of premiums collected. The company spent $214,096 on expenses to support the core operations of our business, or 12.9% of premiums (lowest level since 2008). An additional $37,151 was spent on ACA related taxes and fees, resulting in total administrative expenses of $251,247.
Payments To Providers
$214,096 operating expenses
$37,151 ACA taxes and fees
Net Gain / (Loss)
Gain on Operations
$89.8M IT Infrastructure change in depreciation
$64M in Pension Termination
Excluding these large, one-time, reserve neutral items, the company would have reported net income of $27,954.
In 2015, we added $29,690 over 2014 reserves of $264,045. As a result, reserves held for the protection of our members increased from the prior year and totaled $293,735 at year end. At only 17.7% of annual premium revenue, our reserves are below the 23% minimum recommended by the Office of the Health Insurance Commissioner.
Amount Added to Reserves
This formulation represents unaudited results utilizing Statutory Accounting Principles.
The Blue Cross and Blue Shield Association licenses Blue Cross & Blue Shield of Rhode Island
to offer certain products and services under the Blue Cross and Blue Shield brand names. Blue
Cross & Blue Shield of Rhode Island is an independent organization governed by its own Board
of Directors and solely responsible for its own debts and other obligations. Neither the
Association nor any other organization using the Blue Cross and Blue Shield brand names acts
as a guarantor of Blue Cross & Blue Shield of Rhode Island’s obligations. A copy of Blue Cross &
Blue Shield of Rhode Island’s most recent audited financial statements is available on request to:
Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI 02903.