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September 2009 St@teside

SCI Funds Insurer Affordability Standards Project in Rhode Island

SCI is supporting the implementation of first-of-their-kind affordability standards in Rhode Island.

Rhode Island’s Office of the Health Insurance Commissioner (OHIC) recently embarked on a project to develop clearer priorities and standards for OHIC and health insurers regarding health plan policies that will improve the affordability of the medical care system in the state. The final priorities established through the office’s advisory council will improve the affordability of health care in Rhode Island by attempting to address the inadequacies of current provider payment systems and some of the threats to primary care. The priorities include:

  • Expand and improve the primary care infrastructure in the state (with limitations on ability to pass on in premiums);
  • Spread adoption of the chronic care model-style medical home;
  • Standardize incentives for electronic medical records (EMR); and
  • Work toward comprehensive payment reform across the delivery system.

Standards were developed to reflect these priorities and assure that health plans would be held accountable as a condition of rate factor review. These standards, to be implemented in January 2010, include:

  • Health plans are to be held accountable for increasing the proportion of their medical expenses spent on primary care by five percentage points over the next five years. This money is an investment in improved care coordination, not a simple shift in fee schedules.
  • As part of that, health plans will promote the expansion of the all-payer chronic care-focused patient centered medical home (CSI-Rhode Island) project by at least 15 physicians in the coming year and promote EMR incentive programs that meet or exceed a minimum value.
  • Health plans commit to participation in a broader payment reform initiative as convened by public officials in the future.

In accordance with these standards, carriers were required to submit detailed reporting of baseline spending/performance indicators in August 2009 and an implementation plan this month.

Chris Koller, the health insurance commissioner, recognizes that it is not a foregone conclusion that increased primary care spending will result in improved system performance. Likewise, he recognizes that successful implementation of these standards will require significant OHIC leadership, project support, and program monitoring in the coming year.

Stay tuned for updates on Rhode Island’s progress in implementing the new affordability standards and making a substantial investment in primary care.