Investor Presentaiton
Medicaid Insurers' Performance Against the Cost Growth Target
Unlike in the other markets, all Medicaid insurers met the cost growth target. NHPRI
was the only Medicaid insurer to experience growth in 2021. UnitedHealthcare
Community Plan (UHCCP) and Tufts Health Public Plans' (THPP) PMPM costs decreased,
which we suspect were attributed to growth in members as a result of the public
health emergency continuous coverage requirement for Medicaid, and the fact that
some of those continuously enrolled likely gained commercial coverage. Continuous
enrollment had a more dramatic effect for THPP because its membership was
comparatively low, magnifying the impact of a large influx of members in 2021. THPP
saw a 45 percent increase in membership, while UHCCP and NHPRI's membership
grew at approximately 11 percent (see Exhibit A.3).
Exhibit A.3: Medicaid Insurers' 2021 Performance Against the Cost Growth Target
-12.9% THPP
UHCCP -1.2%
NHPRI 0.8%
-16.0%
-12.0%
-8.0%
-4.0%
0.0%
4.0%
8.0%
12.0%
16.0%
Source: OHIC analysis of TME data from insurers. Target performance is calculated using TME data, after applying truncation and age/sex risk adjustment.
Medicare-Medicaid Plans' Performance Against the Cost
Growth Target
Through CMS' Financial Alignment Initiative, Rhode Island provides coverage to
individuals who are dually eligible for Medicare and Medicaid through a combined
Medicare-Medicaid Plan (MMP). NHPRI was the only insurer to offer such a product
in 2021. Target performance is calculated using TME data, after applying truncation.
MMP spending is not risk-adjusted, as risk-adjustment is not performed at the market
level and NHPRI's population represents the entire population of individuals enrolled
in this market.
For the 2021 performance period, NHPRI's MMP spending growth was 4.5 percent,
which exceeded the target. MMP enrollees tend to have more complex health care
needs and, as a result, higher health care spending per capita.1 This population may
have also experienced more adverse consequences from having to delay care during
COVID-19, resulting in higher spending growth.
1
For more information on Integrity, see: Neighborhood Health Plan of Rhode Island, Neighborhood INTEGRITY (Medicare-Medicaid Plan), accessed March 27, 2023,
https://www.nhpri.org/medicare-medicaid/.
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Annual Report: Health Care Spending and Quality in Rhode IslandView entire presentation