2023 Mission Report

Quality

Affordability

Equity

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Affordability

The cost of healthcare is one of the most pressing issues in Rhode Island and across the country. That’s why we’re expanding initiatives around prescription drugs to lower costs, using new technology to better help members, and bringing new payment models to providers. For members of our community who rely on Medicaid and Medicare services, our D-SNP plan can help provide access to even more affordable care.

affordability

Pursuing lower pharmacy costs

One of the largest drivers of rising healthcare costs is the growing use and increased price of prescription drugs. We have several initiatives underway to help control these costs.

A woman holding a Blue Cross Blue Shield health insurance card.

Prescription savings program

MedsYourWay® is an integrated discount program available to many of our members across the country, and it’s one more way we are trying to bring prescription drug costs down. The program automatically provides members the lowest available price of applicable discount cards for eligible medications—no coupons or other cards needed.1 And those costs will count toward their deductibles.

$169,089
saved by BCBSRI members using MedsYourWay in 2023

In the pipeline

BCBSRI was one of the founding members of CivicaScript™, with a mission to bring affordable versions of high-priced generic medicines to members. CivicaScript will begin manufacturing and distributing three low-cost insulin products in 2024. Stay tuned.

Civicascript

New cell and gene therapy program

Founded by Blue Cross and Blue Shield companies, the Synergie Medication CollectiveSM focuses on improving affordability for drugs that are injected or infused by a healthcare professional, including cell and gene therapies, by purchasing on behalf of 100 million Americans.

Employers can benefit from the approach that Synergie uses in its new Cell & Gene+ offering:

  • Ensure treatment is high quality and more affordable
  • Obtain refunds from pharmaceutical manufacturers if therapies don’t deliver expected outcomes
DNA strand
affordability

Reducing administrative complexity

We’re taking major steps to update, upgrade, and innovate the way we handle information. This will help us reduce administrative costs and put more money toward our members, customers, and providers. These efforts will allow us to serve them more efficiently and more effectively, whether they are in Rhode Island or across the country.

AI to help members

You couldn’t escape talk of artificial intelligence in 2023, and at BCBSRI, we are thinking carefully about how we can put AI to work to improve our operations while ensuring our members continue to get the hands-on support they need. We constantly look for ways to enhance the service we provide, and our early efforts already are showing positive results.

We use generative AI to assist our Medicare Concierge customer service team in documenting calls, which reduces the time they spend after a call. So they get to do more of the thing they love—assisting members.

Employee talking on headset.

We also are using conversational AI to help members when they call. In 30% of calls to our Medicare Concierge team, members get the information they need without waiting to speak with someone, or they get routed directly to the right people who can help them.

9%
reduction in time spent on Medicare Concierge “agent after-call work” after just one month
“Hands down, it makes a major impact. It helps us focus more on the member.”
—Ryan Samuels, Member Service Representative, BCBSRI Medicare Concierge Team

Modernize the data

By creating a modern data hub, we will be able to provide:

  • Personalized member advocacy using a holistic view of our members in one place
  • More efficient experiences for employers and brokers
  • Prescriptive analytics to drive better care management and value-based care
  • Ability to leverage AI and machine learning for better insights from our data

Cloud computing for better service

After a thoughtful, years-long process, we are now working on a cloud computing platform. With this move, we can expect:

  • Improved efficiency
  • Modernized platform with real-time capabilities
  • Significant cost savings
Employees in a meeting.

An easier process for brokers and employers

In 2023, brokers and employers benefited from our simplified small group quoting/rating experience. With a single log-in, brokers are now able to request and receive small group quotes, email quotes directly to clients, sign and route documents electronically, and much more.

affordability

Improving the quality of care

An important way we are tackling affordability is through value-based care (VBC). These people-first care arrangements help providers shift away from rigid fee-for-service models and, instead, focus on reimbursing providers for the quality of care provided, not the quantity of patients seen.

Rewarded for quality, primary care practices can focus on delivering preventive care, proactively, helping patients stay healthy. For example, we are funding pharmacists who help doctors and patients make informed decisions about medication choices and costs.

We and our VBC partners—including Integra, CharterCare, Oak Street Health, Lifespan, and Coastal Medical—are seeing the many benefits of these evolving arrangements.

We have extensive value-based care coverage

900+
primary care providers in RI in VBC arrangements
80%
Medicare members covered in VBC arrangements
65%
commercial members covered in VBC arrangements
Patient in medical gown talking to doctor.

And the evidence over the past several years shows that value-based care is working:

15%decrease
medical admissions
30%decrease
surgical admissions
3%average reduction
medical claims costs in VBC programs2

Protecting the health of members with Medicare and Medicaid

Having both Medicare and Medicaid can be difficult to navigate. That’s why our BlueRI for Duals (HMO D-SNP) plan offers a care model that is unique in Rhode Island. Each member has a health navigator who helps them focus on their health and coordinates their care team. That can range from scheduling appointments to helping ensure members have heat and electricity. In addition to health navigators, members can get assistance from specialists in Medicaid during their annual renewal.

In 2023, we enhanced this $0 premium plan to help meet members’ needs and make their lives easier.

Teressah Tucker, BCBSRI Health Navigator (left), with Brittany Morris, Zach Morris, and their mom, Amey Morris

Nutritious food on the table

  • Funds for groceries3 and $0 delivery
  • The ability to add groceries purchased with a SNAP card to their $0 BCBSRI grocery delivery
  • $0 meal deliveries after a hospital or skilled nursing facility stay (also available to BCBSRI Medicare Advantage members)

Comprehensive, easy-to-use coverage

  • $0 for all covered prescription drugs3
  • Additional funds for vision, hearing, and dental care

Additional help with staying independent

  • More coverage for private rides and help around the house
  • $0 personal emergency response system
“I could never afford to have my children living at home if it wasn’t for this wonderful BlueRI for Duals plan. And their health navigator Teressah is amazing.”
—Amey Morris, mother of two BlueRI for Duals members

Lower costs for ACCESS members

The BCBSRI ACCESS program provides extra benefits for members who may not qualify for our Duals plan. ACCESS includes all of the benefits in our BlueCHiP for Medicare Value (HMO-POS) plan, plus even lower copays, more services, and a growing network of providers, like Oak Street Health, that offer dedicated care teams and take the time to get to know their patients.

Doctor showing a patient information on tablet computer.
affordability

Giving members new options for care

We are offering more ways for members to get the care they need. Some, like Doctors Online4, are not only more convenient but can also reduce claims costs. Others, like care management, help members navigate the healthcare system, reducing barriers and letting them focus on their health.

Doctor video chatting on mobile phone.

Telehealth delivers more than convenience

We know that our members see the convenience of our Doctors Online telehealth service, no matter where they are. If a member is too sick to go to a doctor’s office, or if they can’t take time off during working hours, they are increasingly turning to Doctors Online. Our members are also finding it useful for behavioral health issues, which made up one-third of all Doctors Online visits last year.

But did you know that telehealth also helps lower the cost of care? Member visits in 2023 resulted in more than $236,000 in claims savings, based on where members indicated they would have gone for care if they didn’t use Doctors Online.

2023 VS. 2022

18%increase
BCBSRI members using Doctors Online
43%increase
number of appointments
35%increase
number of behavioral health appointments
69%increase
total claims savings5

BCBSRI Care Managers help thousands of members

Our Care Management team works with members and their providers to get on the path to a healthier life. The BCBSRI team of registered nurses, registered dietitians, behavioral health specialists, and pharmacists help members:

  • Work through vulnerable and high-risk periods such as a new diagnosis or discharge from hospital
  • Manage chronic conditions such as diabetes or high blood pressure
  • Cope with high-risk conditions such as congestive heart failure

There’s no extra cost for these services, and no referral is needed.

Smiling BCBSRI Care Manager talking with BCBSRI member.
10,000+
BCBSRI members helped by Care Managers in 2023
95%
overall satisfaction rate
“I think this is a great program, and it shows that people care about you and are always available if you need them.”
—BCBSRI Member

Care managers go online...

Late in 2023, we began offering visits with our Care Managers through Doctors Online.6 These visits can establish and strengthen the nurse-patient relationship through virtual face-to-face discussions, and they allow the nurse to assess needs in the member’s home. Members also can work on specific health goals while seeing their Care Manager online.

...even in the hospital

When a member told his Care Manager that he had been sent to the emergency room, they arranged a Doctors Online visit from the hospital. The member learned what he should do next and felt more confident in making healthcare decisions. It also helped improve his adherence to follow-up care plans.

A Blue Cross Blue Shield of Rhode Island Care Manager having a video call on a tablet computer.
5/5
rating from members using Care Management online

Recovery at home

Members with substance use disorder now have another option: Aware Recovery Care. We cover home and community-based services available through Aware. BCBSRI members can stay in their own home, rather than going to an inpatient program that might even be out-of-state. At-home services include withdrawal management, medication-assisted treatment, individual therapy, coordinated medical and behavioral healthcare, and family therapy. This model allows families to be involved in the treatment process through regular family sessions and wellness consultations with a licensed therapist.

199
BCBSRI members helped by Aware in 2023

Employers rewarded for employees’ healthy choices

Wellness Premium Reward helps fully insured employers with BCBSRI coverage offset premium costs so they can continue to offer robust health benefits to their employees. The program pays employers a reward based how much their employees earn by making healthy choices in their wellness programs.

Smiling employer group holding oversized checks.

2023 Rewards

3,586
average number of employees who earned rewards each quarter
374
employers earned rewards
$774,908
in premium rewards paid to employers

1MedsYourWay is not insurance. It is a drug discount program administered by Prime Therapeutics, LLC, an independent company contracted by BCBSRI to provide pharmacy benefit management services.

2Compared to members not in VBC arrangements. BCBSRI claims data 2017-2022

3For members who qualify for Extra Help

4Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of BCBSRI.

5Based on where members indicated they would have gone for care if they didn’t use Doctors Online.

6This service is only available to members who have the Doctors Online benefit.