By JIM BARON

PROVIDENCE — Tufts Health Plan, which left the Rhode Island health insurance market at the end of 1999, is planning a comeback.

The Watertown, Mass.-based health insurer has filed applications with the Department of Business Regulation to sell large group and small group policies in the Ocean State.
If Tufts does come back to Rhode Island, a move its CEO says could happen soon, it would be a third major player in a market that has been dominated for years by Blue Cross/Blue Shield of Rhode Island and United Health Care.
“We looked at what people have available to them in Rhode Island, and we think what we offer would be a new value proposition for them,” Tufts CEO James Roosevelt said Thursday. “We think we offer better quality based on national rankings and better value.”
Matthew Stark, principal policy associate for the office of Health Insurance Commissioner, an arm of the DBR, said the reappearance of Tufts in Rhode Island “could benefit consumers in the small and large group markets … there is an opportunity for competitive pressure.”
While Tufts is making preparations, its return to Rhode Island is not a done deal, Roosevelt said.
“We are actively exploring it and we are approaching our final decision stage,” he said. “We have filed the papers and we are talking with providers to make sure we get a fair shake on rates.”
Roosevelt said he has been talking to area hospital CEOs personally in recent weeks because, “we need to know that hospitals and health care systems will give us a level playing field with the other two companies.”
He said Tufts hopes to have commitments from the health care providers on that level playing field and approval from DBR “in six or seven weeks.”
Although Tufts currently only sells to employers and individuals in Massachusetts, they nonetheless have relationships with Rhode Island doctors and health care providers because Tufts clients are their patients.
Asked if a Rhode Islander signing on to Tufts in the future would be able to keep their present doctors, Roosevelt said, “Yes, that is what we are aiming for.”
Competition in the health insurance market, he said, “spurs lower prices and innovation.”
Steven DeToy, director of public and government affairs at the Rhode Island Medical Society, said Tufts Health Plan has a reputation for being, “pretty physician-and-patient-friendly.”
He said they would be “a welcome addition to the market,” putting pressure on United Health Care, which has a less friendly reputation, to do the same.
However, he cautioned, “the way health care is financed, competition does not bring relief to anyone in terms of reducing prices on premiums. The employer community should not be lulled into thinking this would evolve into a reduction in premiums.”
“We have maintained unrelenting focus on reducing administrative costs together with implementing a thoughtful medical management program that has improved quality and reduced unwarranted medical expenses,” Roosevelt said in a press release. “These combined efforts contribute to our ability to offer Rhode Islanders competitive premiums, and in large part, we attribute our membership retention and growth to these commitments.”
“Along with our wellness initiatives, our medical management programs help us responsibly address the issue of rising health care costs,” says Allen Hinkle, M.D., Tufts Health Plan's senior vice president and chief medical officer. “It’s our belief that Rhode Islanders will benefit from this philosophy and we look forward to building strong working relationships with the Rhode Island provider community.”