The 'value' equation: costs and quality of Rhode Island's health plans (2007).

in 2007, over 255,000 (75%) received their health coverage through two domestic plans: Blue Cross and Blue Shield of Rhode Island (Blue Cross), and United Healthcare of New En-gland (United). Information about these plans is essential to determining if purchasers receive " value " from their premium dollars expended. 1 The Act instituted health plan performance reporting in the state, which is summarized annually, and most recently in the Rhode Island Health Plans' Performance Report (2007). 2 The information presented here is derived from that report. The measures are trended over time, compared to the average of health plans in New England, and benchmarked to the best-performing 10% of health plans nationally. RESULTS Rhode Island's commercial health insurance market remains concentrated in two carriers, Blue Cross, with a 2007 market share of 63.0%, and United, with a share of 12.5%. The remainder of the market (24.5%) consists of a number of smaller plans, none of which are domiciled in Rhode Island. To assess whether the purchasers of these plans' products are receiving 'value,' one must examine its two components, cost and quality. For Rhode Islanders to receive good 'value' from their investment in health insurance, that coverage should be equivalent or less expensive and deliver the same or better quality services than elsewhere. On average in 2007, commercial health insurance cost significantly less in Rhode Island than in New England. (Figure 1) Blue Cross's monthly premiums were 12% lower than regional premiums ($333 vs. $379), and United's premiums were 14% lower ($325 vs. $379). In addition, both Rhode Island plans spent considerably less on medical services for their members (13% less for Blue Cross and 21% less for United). With few exceptions, both Blue Cross and United generally performed above average when their clinical quality measures were compared to the New England values. (Table 1) For Blue Cross, 11 of its 19 quality measures were equivalent to the regional averages, five measures were better, and the remaining three were worse than these comparables. For United, 12 of its 19 quality measures were equivalent to the regional averages, four measures were better, and the remaining three were worse than these comparables. Given that New England health plans consistently post some of the highest quality (and satisfaction) scores in the country, this regional comparison provides a fairly rigorous benchmark for Rhode Island plans. No matter how acceptable an individual plan's relative performance …