15 percent is just the beginning


Last year, with the implementation of the Affordable Care Act (ACA) and the public health insurance exchanges, many were surprised to learn that, while this law aims to provide every American with access to affordable health care coverage, it does not, in and of itself, reduce the cost of health care.  

Real change in our health care system is a monumental task that will take time and sustained effort. It will also require a significant commitment to partnerships between all stakeholders (physicians, hospitals, insurers and government) in which everyone is thinking differently about their role in improving Rhode Island’s health care system and shifting their behavior accordingly. We need to do more and we need to move faster; our customers, the business community and the general public are demanding it.

On May 15, Blue Cross & Blue Shield of Rhode Island (BCBSRI) and other local health insurers filed proposed 2015 commercial rates, including those for individuals, large and small employer groups. Our filings reflected average rate increases of 12 percent for individuals and families, 10 percent for the large business community and 8 percent for the small business community. These increases are lower than they were last year, but heading in the right direction doesn’t mean we’re close to the finish line. To truly get costs as low as we’d like, everyone will have to do their part to fix fundamental flaws in the way we finance health care.

We recently filed for approval with the Office of Health Insurance Commissioner a new product that, if approved, would provide Rhode Islanders a new, lower cost alternative. Compared to other products in the market today, this plan will offer richer benefits and cost 15 percent less. It will offer customers more coordinated care at lower costs and improved benefits when members receive care within the preferred network of providers.

It’s a start, as we work toward the goal of ensuring that more affordable coverage options are available for all Rhode Islanders. This new product is made possible through collaboration between BCBSRI and the CharterCare Health System.  

This partnership and product illustrate the importance of collaboration among stakeholders to transform the existing, broken health care financing system. At Blue Cross, we’re working every day with leading hospitals, physician groups and other providers to make important changes that focus on improving patient care and outcomes. Recent examples include:

In collaboration with Care New England and Continuum Behavioral Health we launched a two-year pilot program called HealthPath to provide a coordinated system of care for members with serious mental illness; an agreement with South County Hospital and South County Orthopedics, creating a bundled payment for hip and knee replacements; shared-savings agreements with Coastal Medical and University Medicine to further improve health care quality, patient safety and lower costs; introduction of a triple-zero Medicare product designed around the Patient Centered Medical Home (PCMH) model; and a soon to be announced, first in the state, global payment agreement with Rhode Island Primary Care and Care New England to provide new care models for our Medicare Advantage members.

Each of these new programs is based on the premise that physician-led, team-based, patient-centered care is the future of health care. We recognize that to create a real system of care and to lower costs, care must be better coordinated. Providers and insurers must have aligned interests and incentives to provide evidence-based, effective care, to work as a team and to engage patients.

Through our work so far, we’ve learned that transforming our health care system requires cooperation, alignment and a lot of hard work; it can’t be done by hospitals, physicians, insurers or the state government alone. Thanks to the efforts of stakeholders throughout the state, we’re beginning to see more collaboration and some positive results. But we must do more, and faster.

Peter Andruszkiewicz is president and CEO of Blue Cross & Blue Shield of Rhode Island.


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