OHIC sets new standards for health care delivery by end of decade

R.I. HEALTH INSURANCE COMMISSIONER Dr. Kathleen C. Hittner has promulgated new regulations for health insurers and health care providers designed to improve quality and lower costs through the use of patient-centered medical homes and accountable care organizations.  / PBN FILE PHOTO/TRACY JENKINS
R.I. HEALTH INSURANCE COMMISSIONER Dr. Kathleen C. Hittner has promulgated new regulations for health insurers and health care providers designed to improve quality and lower costs through the use of patient-centered medical homes and accountable care organizations. / PBN FILE PHOTO/TRACY JENKINS

CRANSTON – R.I. Health Insurance Commissioner Dr. Kathleen C. Hittner has adopted several new standards likely to produce important changes in health care delivery in Rhode Island in the next several years.

The changes are written into amendments to the powers and duties of Office of the Health Insurance Commissioner. Hittner approved the changes on Feb. 2, and announced them in a statement on Feb. 6.

The amendments will go into effect Feb. 23. The amendments are an update to the state’s Affordability Standards first implemented in 2010 and represent a continuation of shifts both in health care delivery and insurance practices.

“The Office of the Health Insurance Commissioner is striving to move the health care delivery system in a direction that will not only slow the growth of health care costs, but also improve the efficiency and quality of the care that is being delivered to Rhode Islanders,” Hittner said in a statement.

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Central to the amended standards is the promotion of the patient-centered medical home care model. The new standard requires that each health insurer doing business in Rhode Island take necessary steps to insure that by Dec. 31, 2019, 80 percent of the state’s primary care practices are functioning as patient-centered medical homes.

The OHIC estimates that the current percent of practices transforming themselves into patient-centered medical homes to be 45 percent, or just under half of the goal.

The standard forces insurers to promote patient-centered medical homes through incentives in the provider contracts they write and specifically through disincentives as well.

The amended standards also encourage the proliferation and growth of accountable care organizations, which use patient-centered medical home principles but on a larger platform. The standard casts accountable care organizations, and insurers’ working closely with them, as vital to the state’s effort to cap costs.

In addition, the new standards require hospitals to “realign payment to provide incentives for efficient use of health services, and are derived from nationally utilized payment practices other than fee-for-service. Nothing in this requirement prevents contract terms that provide additional or stronger payment incentives toward quality and efficiency such as performance bonuses, bundled payments, global payments or case rates.”

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