Media Release

For Immediate Release
Date: February 8, 2006
Contact: Bruce Cryan (401) 222-5123

RI Health Department Evaluates Commercial Health Plans
High Rates of Emergency Department Use Suggest Imbalance in Health Care System

Today, the Rhode Island Department of Health (HEALTH) released the RI Commercial Health Plans’ Performance Report . This study details the performance of the state’s five largest commercial health plans. Although Rhode Island’s health plans compared favorably with regional and national benchmarks on most clinical quality and access measures, several of the 28 measures evaluated in this report highlight the opportunities health plans have to help build a more balanced health care system in Rhode Island.

In general, the inappropriate use of emergency department for primary care may mean that there are barriers to accessing primary care at the right place when people need it, even among people with health insurance. Among Rhode Islanders enrolled in commercial health plans, the rate of visits to hospital emergency departments that did not result in hospital admission exceeded the U.S. average by ten percent.

“Rhode Island’s health plans should be commended for their ongoing commitment to quality improvement,” said Christopher F. Koller, Health Insurance Commissioner. “However, the release of this 2004 performance report indicates that we need the health plans to do more to help improve the balance of health care delivery in Rhode Island. The inappropriate use of hospital emergency departments is one driver of health care cost, and greater support for primary care providers in Rhode Island by health plans could lead to more cost-effective care delivery and improved performance on these measures of clinical quality and access.” Koller is leading a statewide effort to create a more balanced health care delivery system in Rhode Island as part of Governor Donald L. Carcieri’s health policy agenda.

Overall, Rhode Island’s health plans performed well on measures of clinical quality and access. “Rhode Island’s health plans deliver preventive services, like advising smokers to quit, more often other health plans nationwide,” said David R. Gifford, MD, MPH, Director of Health, citing that over 80% of health plan members that were smokers received advice to quit in 2004. This measure has improved since 2002 and places Rhode Island’s plans in the top 10% nationwide for this measure. “However, some indicators also point to the need for better chronic care management in primary care settings. Too few health plan members receive recommended treatment for a new episode of depression, or follow-up to inpatient treatment for mental illness,” added Gifford.

The full report is available on HEALTH’s Web site at www.health.ri.gov. For more information on this report, contact author Bruce Cryan at (401) 222-5123.