A primary care center of their own: addressing the needs of Medicare Advantage members in Rhode Island

It’s no secret our nation is aging, and a growing number of older Americans have at least one or more chronic diseases. Caring for patients with more complex needs is challenging healthcare systems across the country, but the situation is even more pressing in Rhode Island. The Ocean State has the nation’s highest percentage of people over the age of 85, and one of the largest percentages of residents over the age of 65, according to the U.S. Census Bureau. That’s why Blue Cross & Blue Shield of Rhode Island (BCBSRI) is investing in new ways to keep its Medicare Advantage members healthier longer. 

The move reflects a growing awareness that Medicare Advantage members may need more from their insurer than what’s traditionally been covered, such as transportation to doctor’s appointments. New rules from the Centers for Medicare & Medicaid Services have opened the door for health plans like BCSBRI to offer more of those services.

A new primary care model for Medicare Advantage members

BCBSRI has partnered with Oak Street Health, a network of primary care centers catering to Medicare patients. Oak Street Health follows a model that is based on value for its patients, not on the volume of services. Their value-based care model allows providers to spend, on average, more than twice as long with patients and address additional risks to a patient’s health that might be overlooked by a traditional doctor visit, such as a lack of transportation or access to behavioral health resources. 

The centers, opening throughout 2019, will be located near neighborhoods that lack primary care practices for Medicare members. By building in these locations, BCBSRI and Oak Street Health can assist those affected by social determinants of health – such as access to transportation, availability of healthy food, stability of housing and more. The centers will provide transportation to and from appointments, offer wellness activities such as fitness classes, operate as heating and cooling centers when necessary, and combat isolation and loneliness by providing social engagement activities like cooking classes. Oak Street Health clinicians can also provide home care when needed.

Moving beyond healthcare to health and well-being

BCBSRI President and CEO Kim Keck recognizes that doctors who care for older patients need the flexibility to address the whole patient, from the physical ailments and behavioral health issues that may hamper a senior’s quality of life to the socioeconomic barriers that prevent them from accessing care or maintaining their health at home. Moving away from paying doctors a fee for each service they provide to paying them for the overall quality of care can give doctors that flexibility. Keck says these models are leading the way to better health for seniors in Rhode Island and beyond.

“This partnership with Oak Street Health will catalyze a completely new kind of healthcare delivery that reflects our vision of passionately leading a state of health and well-being across Rhode Island,” says Keck. “Now, we are collaborating with an organization that takes this same approach to providing care, especially for our members, whose complex conditions span physical and behavioral health.”   

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.