Standards to improve health care delivery, payment systems adopted

R.I. HEALTH INSURANCE COMMISSIONER Dr. Kathleen C. Hittner said her office has adopted new standards to improve health care delivery. / PBN FILE PHOTO/TRACY JENKINS
R.I. HEALTH INSURANCE COMMISSIONER Dr. Kathleen C. Hittner said her office has adopted new standards to improve health care delivery. / PBN FILE PHOTO/TRACY JENKINS

CRANSTON – State Health Insurance Commissioner Dr. Kathleen C. Hittner said her office has adopted standards to improve health care delivery and payment systems, a step that aligns her office with the governor’s efforts to strengthen the health care system for all Rhode Islanders.
In March, the R.I. Office of the Health Insurance Commissioner convened two advisory committees to develop recommended plans to expand the use of health care payment methods that reward efficiency and quality, instead of volume, and to increase the percentage of insurer-contracted primary care practices that are operating as patient-centered medical homes.
The commissioner approved the plans, making them standards to enforce.
“My office is committed to holding premiums in check through our annual rate review process and directing insurers toward practices that change the fundamental factors underlying high medical expense growth rates,” Hittner said in a statement. “OHIC’s new standards will address those fundamentals by rewarding cost efficiency and quality, instead of volume, and further enhancing primary care’s ability to manage population health and total cost of care.”

Through the Care Transformation Plan, insurers must increase the percentage of their primary care network functioning as a patient-centered medical home by 5 percentage points for 2016, with a target of 80 percent of Rhode Island primary care clinicians practicing in a PCMH by 2019.

The Alternative Payment Methodology Plan establishes payment reform targets for commercial insurers, setting a target for at least 30 percent of insured medical payments to be made through an alternative payment model by 2016.

“OHIC’s Affordability Standards support our efforts to make health care more accessible and affordable for all Rhode Islanders,” Health and Human Services Secretary Elizabeth H. Roberts said in prepared remarks. “We will continue to work closely with OHIC and align targets as we build a more innovative health care system.”
According to a news release from Hittner’s office, the new standards, along with Gov. Gina M. Raimondo’s efforts to reinvent Medicaid and improve health care, represent “a major step toward transitioning to health care payments based on value.”
The release said medical expense growth rates for commercially-insured consumers continue to exceed general inflation, driving up health insurance premiums.

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As a result, improvements in efficiency and delivery of health care delivery should produce more affordable health insurance premiums in the future, the release states.

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