Blue Cross & Blue Shield of Rhode Island submits proposed individual and small group rates for 2018


Blue Cross & Blue Shield of Rhode Island (BCBSRI) has filed proposed 2018 rates with the Office of the Health Insurance Commissioner (OHIC) for individual and small group customers; large group customer rate requests were submitted in May. If approved, the proposed rates will result in average premium increases of 13.9 percent for individuals and 8.6 percent for small group employers. Actual rate increases will vary depending on age and plan selection.

The main drivers of the proposed premium increases are the cost of healthcare and the amount of healthcare services used. In fact, more than 6 percentage points of the increases are driven by these factors. Additionally, the reintroduction of the federal health insurer tax, which was temporarily suspended in 2017, adds 1.5 percentage points to the small group filing and 2 percentage points to the individual filing. The individual filing also includes 3 percentage points attributed to new information about the federal risk adjustment program. BCBSRI’s individual market rate is among the lowest filed nationally. More than 40 percent of states have filed rates in excess of 20 percent.

“At Blue Cross, we are committed to making healthcare affordable, accessible, and simple for Rhode Islanders,” said BCBSRI President and CEO Kim Keck. “Our 2018 rates reflect real expenses tied to the rising cost of medical care and prescription drugs. We are committed to working with providers and consumers to more effectively control these costs.”

In 2016, prescription drugs and care provided by specialists such as orthopedists and cardiologists made up nearly 50 percent of BCBSRI’s total healthcare costs.

“This is a critical moment for our state in addressing the challenge of healthcare affordability. We have to accelerate our adoption of new care models, introduce innovative products into the market, and enable providers, employers, and members to access technology tools that can facilitate smarter choices about care,” said Keck.

BCBSRI is focusing on several initiatives to achieve affordability, including:
·         Accelerating value-based payments to systems of care, where care is well coordinated among primary care providers, specialists, pharmacists, and hospitals. This model can improve quality and may result in lower healthcare costs.
·         Introducing improved technology tools that help members make more informed choices based on quality and cost.
·         Expanding the number of members who participate in plans that earn incentives for healthy behaviors.
·         Expanding participation in consumer-driven health plans, which offer a number of options for cost savings.

According to Gus Manocchia, M.D., senior vice president and chief medical officer at BCBSRI, major components that will drive healthcare affordability are the transformation of the care delivery system and changing current reimbursement models, which have historically been built around paying a fee for each service provided to the patient, or fee-for-service payments

“In the last several years, Blue Cross has made significant investments in primary care to drive adoption of a coordinated care model that puts patients at the center and moves away from a fee-for-service mentality. There is no doubt we need to do more,” Manocchia said. “While primary care providers were among the first to adopt this sort of model, we must ensure that specialists do as well. This view and directive is imperative as we continue to shift to a reimbursement model that rewards quality, patient care outcomes, and value.”

BCBSRI expects a decision from the OHIC in mid to late summer. 

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