|BCBSRI and Integra Forge Innovative Agreement|
A new agreement between Blue Cross & Blue Shield of Rhode Island (BCBSRI) and Integra Community Care Network, LLC (Integra) will provide 60,000 BCBSRI members a new model of coordinated healthcare delivery. Integra is the partnership of Care New England Health System (CNE) and its network physicians, Rhode Island Primary Care Physicians Corporation (RIPCPC), and South County Health and its network physicians. Focused on population health management, the contract creates incentives for Integra’s providers to proactively manage patient health needs.
“Keeping patients well and out of the hospital is the core premise behind population health management,” said Dennis D. Keefe, chairman of the Integra board of managers and president and CEO of Care New England. “With the focus on highly accessible, excellent primary care and a host of new support services and tools, our agreement with BCBSRI gives us the opportunity to explore new ways of working with our patients to proactively manage health needs.”
In a first for Rhode Island, eight new primary care access centers, affiliated with Integra and strategically located across the state, will provide same day care for urgent health issues. Additional centers will be added in the future depending on the needs of the community. Ensuring members have immediate access to primary care will reduce unnecessary use of higher cost emergency rooms, while dramatically improving the patient experience. The primary care access centers will be open seven days a week. Additionally, Integra and BCBSRI will jointly fund a patient support hub to coordinate all aspects of a patient’s care, including scheduling specialist visits, providing support in accessing healthcare resources, and identifying and addressing preventive care needs.
The new primary care access centers are located at:
Pilgrim Park Physicians
Joseph Grande, M.D.
1243 Post Road
Warwick, RI 02886
Primary Care Walk-in Center
Constantine Vafidis, M.D.
684 Warren Avenue
East Providence, RI 02914
South County Walk-in & Primary Care
Monica Gross, M.D.
360 Kingston Road, Suite 104
Narragansett, RI 02882
North Smithfield Urgent Care
John Solomon, M.D.
594 Great Road, Suite 103
North Smithfield, RI 02896
South County Hospital Medical & Wellness Center
3461 South County Trail
East Greenwich, RI 02818
Katherine Williams, M.D.
400 Bald Hill Road
Warwick, RI 02886
Just Kids RI Sick Care
Peter Yasigian, M.D.
2 Meehan Lane
Cumberland, RI 02864
Lincoln Urgent Care
John Solomon, M.D.
2 Wake Robin Road
Lincoln, RI 02865-4241
“From innovative, customer-focused features like the new primary care access centers to improved coordination of care, Blue Cross is committed to working with our provider partners to improve access to care and simplify our members’ experience,” said Peter Andruszkiewicz, president and CEO of BCBSRI. “We’re confident this approach improves quality of life for Rhode Islanders and lowers costs – which is good for our customers and our partners at Integra.”
“We are closing a loop in healthcare in a way that has never been done before in Rhode Island,” said Al Puerini, MD, president of Rhode Island Primary Care Physicians Corporation and vice chairman of the Integra Board of Managers. “This is about improving outcomes and enhancing the patient experience of care by offering care that fosters better access, care coordination, exchange of information, and referral management. Our primary care providers are partnering with specialists, ERs, urgent care centers, hospitalists, nursing homes, home care agencies and other healthcare providers to work closely together and truly coordinate our patients’ care throughout their healthcare journey.”
“We are pleased to be part of this important initiative, which will provide individuals with the tools they need to improve and safeguard their health,” noted Lou Giancola, president and CEO of South County Health. “It reflects our commitment to the community and to our providers.”
The new collaboration advances a commitment that began in 2014 by BCBSRI, CNE, and RIPCPC to develop new models of clinical and financial collaboration, focused on improving the quality and cost of healthcare, as well as the patient’s experience within the healthcare system. In July 2014, the entities announced the creation of Rhode Island’s first fully integrated payment model to cover approximately 10,000 BCBSRI Medicare Advantage Members. The arrangement built on a partnership BCBSRI and CNE reached in August 2013 in which the two organizations pledged to work toward the advancement of population health in Rhode Island. That same year, CNE and RIPCPC executed an affiliation agreement, and, in the following year, Integra was formed. South County Health joined Integra in 2015.
Integra is the only provider-based accountable care organization (ACO) in Rhode Island to be certified as a Medicare Shared Savings Program participant.
From an initial cohort of approximately 19,300 patients in 2014, it is projected Integra will be responsible for more than 120,000 covered lives in 2016, including the recent additions of Rhode Island Medicaid and behavioral health populations.
“Our greatest opportunity is to make inroads in the area of complex care management, including those with co-morbidities and with behavioral health problems,” said James Fanale, MD, chief clinical officer at Integra. “We know that 5 percent of the population accounts for 50 percent of the costs in healthcare. But, it is so much more than saving money. By improving the care coordination through our physicians, nurse coordinators and care navigators, we are reducing reliance on fragmented and disjointed services and building a better system of care for both our patients and their families.”
Integra Community Care Network, LLC 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. Effective January 1, 2016, Integra was also named as an Accountable Entity by the RI Executive Office of HHS and will assume responsibility for more than 30,000 Rite Care participants later this year.
Care New England is an integrated health system which includes primary care and specialty physicians from Kent, Memorial, Women & Infants, and Butler Hospitals, as well as their Physicians Health Organizations (PHOs), The Providence Center, and the VNA of Care New England.
Rhode Island Primary Care Physician Corporation is an independent practice association (IPA) of primary care physicians located throughout Rhode Island and represents 150 physicians from family practice, internal medicine, and pediatrics, who care for more than 220,000 Rhode Island patients.
South County Health is the preeminent resource for healthcare in Washington County, RI, and beyond. Supporting community-based initiatives that improve health, it encompasses five healthcare entities: South County Hospital, South County Home Health, South County Medical Group, South County Quality Care, and South County Surgical Supply. Together, they provide a continuum of care and comprehensive range of advanced inpatient, outpatient, and home health services. www.southcountyhealth.org
Blue Cross & Blue Shield of Rhode Island is the state’s leading health insurer and covers more than 450,000 members. The company is an independent licensee of the Blue Cross and Blue Shield Association. For more information, visit www.bcbsri.com, follow us on Twitter @BCBSRI, and like us on Facebook at fb.com/bcbsri.