Published April 14, 2016
Integra Community Care Network, LLC, and UnitedHealthcare Community Plan of Rhode Island have launched a Medicaid accountable care entity to improve health outcomes, increase patient satisfaction and reduce the overall cost of care for people enrolled in UnitedHealthcare Medicaid plan.
UnitedHealthcare is collaborating with physician groups as part of the State of Rhode Island Accountable Entities Pilot to improve coordination of care for people enrolled in Medicaid. This is the first accountable care entity to be launched in Rhode Island for people served through Medicaid.
Through this joint effort, which began with passage of Rhode Island Governor Gina M. Raimondo's Reinventing Medicaid Act of 2015, UnitedHealthcare and Integra will work closely to better coordinate patients' care, using shared technology and information about emergency room visits and hospital admissions, and services that help patients manage their chronic health conditions and encourage healthy lifestyles. This will make it easier to share important health information among physicians involved in patients' care.
The Reinventing Medicaid Act of 2015 is a comprehensive, progressive package of reforms that positions Rhode Island to transform its Medicaid program and achieve tens of millions of dollars in savings each year without cutting Medicaid eligibility or reducing benefits, according to the state.
UnitedHealthcare and Integra's accountable care program changes the incentives so that care providers have a shared responsibility for the overall cost of care, moving away from a system that reimburses for quantity of services provided to one that rewards the quality of patients' health outcomes and has the potential to reduce overall costs. More than 20,000 people enrolled in UnitedHealthcare's Medicaid health plans in Rhode Island will benefit from this collaboration.
"From the start, our work to Reinvent Medicaid was driven by the goal to expand access to care, improve quality and coordination, and lower costs for taxpayers," said Gov. Raimondo. "Accountable entities like this will reward collaboration and help spark transformation throughout Medicaid. I applaud Integra and UnitedHealthcare for leading the way on this effort."
The Integra care provider network is composed of the Care New England and South County Health systems, Rhode Island Primary Care – the state's largest primary care organization – and a number of independently employed and community physicians. In addition, Integra has formed a network of primary/urgent care providers who have extended hours in the evening, weekends and holidays. This network will give patients access to needed care during off-hours without requiring a visit to a hospital emergency room.
"The goal of an accountable entity is to improve the health and health care of the people we serve. We believe that the state's patient-centered medical home initiatives established a strong foundation for this approach. UnitedHealthcare has been a long-time supporter of the value primary care providers can bring to coordinating care and thereby better controlling costs," said James E. Fanale, M.D., chief clinical integration officer of Care New England, and chief clinical officer, Integra Community Care Network, LLC.
"Rhode Island Primary Care's mission has always been to provide the best possible care to our patients," said Albert Puerini, M.D., president of Rhode Island Primary Care. "We feel that this innovative partnership will help our patients better navigate the complicated health care system. Our goal is to keep the patient central in the health care continuum through broad coordination of care emphasizing prevention, education and positive lifestyle changes."
UnitedHealthcare will support overall population health, giving the entire care team clear, actionable data about individual patients' health needs, potential gaps in care and proactive identification of high-risk patients. Community-based health workers and care managers will also be used to support community-based care coordination, such as helping with planning after a patient is discharged from the hospital and scheduling follow-up appointments.
"UnitedHealthcare and Integra are working together to help people receive more personalized and better coordinated care, which will significantly enhance people's ability to live healthier lives," said Patrice Cooper, CEO of UnitedHealthcare Community Plan of Rhode Island.
UnitedHealthcare serves nearly 300,000 Rhode Island residents with network of 15 hospitals and more than 4,500 physicians and other care providers statewide.
More than 14 million people enrolled in UnitedHealthcare plans across the country have access to accountable care programs, delivered in part through more than 750 accountable care arrangements nationwide as the organization engages in deeper, more collaborative relationships with physicians and hospitals.
Care providers nationwide are showing strong interest in a shift to value-based care. UnitedHealthcare's total payments to physicians and hospitals that are tied to value-based arrangements have tripled in the last three years to $46.7 billion. By the end of 2018, UnitedHealthcare expects that figure to reach $65 billion.
For more information about UnitedHealthcare's full spectrum of value-based initiatives, visit www.UHC.com/valuebasedcare.
Integra Community Care Network is a CMS certified ACO with more than 100,000 covered lives. Its participating provider network includes Rhode Island Primary Care, PC, Care New England and South County Hospital and employed and affiliated physicians. Integra was also named as an Accountable Entity by the RI Executive Office of HHS and assumed responsibility for more than 30,000 Rite Care participants, effective January 1, 2016.
UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers, military service members, retirees and their families, and Medicare and Medicaid beneficiaries, and contracts directly with more than 1 million physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company. For more information, visit UnitedHealthcare at www.uhc.com or follow @myUHC on Twitter.