Hittner jumps back into reform fray

HEALTHY IDEAS: R.I. Health Insurance Commissioner Dr. Kathleen C. Hittner says that as a next step in the effort to reduce medical-service utilization, she wants the R.I. Chronic Care Sustainability Initiative to bring hospitals into the discussion. / PBN PHOTO/TRACY JENKINS
HEALTHY IDEAS: R.I. Health Insurance Commissioner Dr. Kathleen C. Hittner says that as a next step in the effort to reduce medical-service utilization, she wants the R.I. Chronic Care Sustainability Initiative to bring hospitals into the discussion. / PBN PHOTO/TRACY JENKINS

Dr. Kathleen C. Hittner was retired, and she and her husband were building a retirement home in Hilton Head, S.C., when Gov. Lincoln D. Chafee called and asked her to succeed Christopher F. Koller, the state’s first and only health insurance commissioner during the last eight years.
At first, Hittner was reluctant to return to the health care fray, saying that she had no intention to going back to work. But then, as she told Providence Business News, she realized “There’s no better time to be in this kind of position and help to move the health care system in the next direction.”
Rhode Island is on the cusp of major changes in its health care delivery system. And Hittner, a former hospital CEO, will often be at center stage. She’ll oversee insurance rates, the expansion of the R.I. Chronic Care Sustainability Initiative to more than one-quarter of the state’s 1 million residents, and co-chair the R.I. Health Care Planning and Accountability Advisory Council, charged by the General Assembly with drilling down into health care costs.

PBN: What are your thoughts on the issue of medical costs and medical spending? Do you think that Rhode Island, similar to what Massachusetts has done, will create a cost commission? Or consider a cap of rates?
HITTNER: It’s a critically important part of the work of our organization to do rate reviews. We have a very important part of our directive, which is insuring the solvency of the insurers. So that’s part of what we have to look at.
We just put in for a federal grant, which hopefully we will get, for $2.7 million for rate review, to go more in-depth, to do the kinds of things you’re talking about, to look at costs particularly and also, to make sure people understand what the costs are.
Everybody uses the word “transparency.” I like to say that the people who are using the health insurance will need to understand what they’re paying for, deductibles and things of that nature. Yes, there is a lot of work to be done. But I have a lot of thinking to do and learning to do before the word “caps” enters this discussion, because of the solvency issue.

PBN: What do you see as your role in working toward reducing the rates of medical utilization?
HITTNER: All of this is an extremely complex topic, but I don’t think we can solve the whole thing unless we involve many other players. So, for example, one of the things I want to see happen next, with CSI-RI, which is quite big now, is to involve hospitals and bring them into the discussion. So that the caregivers in the patient-centered medical homes are working with the hospitals to decrease hospital admissions and readmissions, making it a smooth transition. So that the physicians know what happened in the hospital, and can take care of that patient in the office and hopefully keep the patient out of the hospitals. To me, that’s where [savings] are, having the hospitals and the caregivers work together. We have to have everybody work together – bring the patients and the business owners. But, right now, the next step to me is, [bringing together] the CSI participants and the hospitals with the insurance carriers.
The hospitals are going to be working to keep people out of the hospital. That’s how they will make their money.

PBN: That’s quite a change in the hospital business model – moving from the hospital as hotel to the hospital as keeping patients away.
HITTNER: I used to say when I ran a hospital that I had to turn those lights on every morning; I’ve got to keep it full. It’s a different attitude now, in discussing how to keep people out of the hospital.

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PBN: What will be the biggest learning curve for you?
HITTNER: Clearly, the biggest learning curve for me is going to be learning the insurance side of the industry. Now, I’m not a novice to it. I have been a provider. I have run a hospital. I have been on boards of malpractice insurance companies for a long time. Lifespan is self-insured; I served on their board for the whole time I was president of Miriam Hospital and a few years after that.
I was concerned about that part of the job, and I spent a long time talking to Chris Koller about that, and the staff that we have, and the actuaries that we have. I’ve met with the [R.I. Department of Business Regulation], which interacts with us a lot. I feel very comfortable that I will be able to handle that.
My biggest role will be taking the information they give me from their actuarial analysis and making a decision on what our rates should be. That part I think I can handle pretty well.

PBN: And the biggest challenge?
HITTNER: I had retired. I had no intention of going back to work. I was enjoying myself. My husband and I are building a house in Hilton Head, S.C., and when the governor asked me to do this, at first, I was [reluctant]. And then I said, “Wow. Just look at the time that we’re talking about right now.” There’s no better time than to be in this kind of position and help to move the health care delivery system in the next direction, I think it has to be done. Over the years, I have formed my own opinions on what should be done in Rhode Island.
Now those opinions have to be informed by listening to the community and the other people involved.

PBN: What kinds of new analytics will OHIC consider using when looking at how to achieve better-quality outcomes in health care?
HITTNER: The way I think that insurance companies are going to get at quality is by doing different contracts. And I think this is what we’re talking about now, the quality. There’s the cost end, and there’s the quality end. What I mean is that they are going to do contracts that reward people for better outcomes. We don’t have outcome measures yet, but we reward people for better performance – if everyone got their proper immunization, did you check the foot on a diabetic patient – all those things now that insurance companies are incentivizing in doctors’ offices.

PBN: How do you see the issue of parity in behavioral health? How do you think that mental-health providers fit into the health care delivery system? There have been concerns raised by some providers regarding cutbacks in fee schedules and limits placed on the amount of time available for patient sessions.
HITTNER: I’m going to give you a little bit more of a bold answer. Perhaps I shouldn’t do that, but I’m going to anyway. The way we’re going to deliver health care is a lot different than it was 25 years ago. I think the role of mental-health providers is going to be different than it was 25 years ago.
One of the things that Chris Koller was very fond of was promoting primary care and participation in patient-centered medical homes – the CSI-RI project. That project has expanded greatly. One of the goals of that project is to really embed mental-health workers in the delivery system, right at the primary-care level.
I don’t want to think about it as just paying a fee for service. But [rather], how we can take these health care workers and put them in a place where they can do the most good and where they’re treated fairly with reimbursements. •

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