Media Release

For: Immediate Release March 28, 2005
Contact: Robert Marshall Ph.D. 401-222-1017

RI Health Department Evaluates Commercial Health Plans-2003; Premiums, Profits and Quality Up; Satisfaction Down Slightly

Today, the Rhode Island Department of Health (HEALTH) released a study detailing the performance of the state’s four largest commercial Health Plans. The RI Commercial Health Plans’ Performance Report compares results in 2003 with those of previous years and to regional and national benchmarks.

In 2003, statewide Health Plan premiums increased 10% ($226 to $248 per member per month -PMPM), and profits rose 37% ($6.30 to $8.60 net income PMPM). Compared to their national counterparts, RI premiums were 25% higher in 2003 ($248 vs. $198 PMPM). The profitability of RI plans surpassed that of national plans by 25% ($8.60 vs. $6.89 net income PMPM). RI medical and administrative expenses were 26% and 22% higher than national plans, respectively.

RI Plans were also 20% less profitable than New England Plans ($8.60 vs. $10.72 net income PMPM)--although RI premiums were only 5% less ($248 vs. $261 PMPM). The medical and administrative expenses of RI Health Plans were 4% and 2% less, respectively, than New England Plans.

In addition to these financial statistics, the Report also presents other performance measures divided into eight separate categories: enrollment, utilization, prevention, screening, treatment, access, satisfaction and utilization review.

“This report demonstrates an ongoing commitment to quality improvement among Health Plans in Rhode Island,” said David R. Gifford, MD, MPH, Acting Director of the RI Department of Health. “Positive results occur when Health Plans respond to public information about quality and other aspects of health services.”

RI Health Plans performed quite favorably on the 20 clinical quality and access measures in 2003. RI performance improved on 8 measures (40%), and held steady on the remaining 12 measures (60%). In addition, RI surpassed the national benchmarks on 12 of these 20 measures (60%), and equaled the benchmarks on the other 8 measures (40%). Regionally, RI surpassed the New England benchmarks on 4 measures (20%), equaled the benchmarks on 10 measures (50%), and fell below the benchmarks on the remaining 6 measures (30%).

Satisfaction with RI’s Health Plan rate declined marginally (-4%) in 2003 (68.6% to 66%). Still, Rhode Islanders were more satisfied with their Health Plans and their healthcare than regional or national counterparts. RI minorities reported about the same level of satisfaction with their healthcare as non-minorities, but they were 7% more satisfied with their Health Plans in general, and 11% less satisfied with their doctors.

Author Bruce Cryan notes that public reporting promotes accountability and helps focus self-improvement efforts within the Plans. This report , and a companion report on RI’s Medicare and Medicaid Health Plans, are available on HEALTH’s website.