New standards set for health insurance providers

Commercial health insurers in Rhode Island will need to have 50 percent of their payments based on quality by 2018 under a new plan announced by the Office of the Health Insurance Commissioner (OHIC) Thursday.

Shared goals between public and private payers are seen as crucial to the success of healthcare reform efforts. The Alternative Payment Methodology Plan is meant to further align commercial insurance payments with those of public payers-Medicare, and the state’s nationally recognized reinvented Medicaid program.

Beginning in 2017, commercial health insurers will be required to direct 40 percent of medical payments through quality and efficiency-based payment models, increasing to 50 percent in 2018.

Along with the alternative payments plan, OHIC also released this year’s Care Transformation Plan, which requires insurers to continue to grow and support patient-centered medical homes.

This all comes out of OHIC’s Affordability Standards, which were first established in 2009 by then-commissioner Chris Koller. Under the direction of the current Commissioner, Dr. Kathleen Hittner, OHIC updated and enhanced the Affordability Standards last summer following a year-long public review and input process.

Included in the new Standards was the establishment of two advisory committees charged with developing yearly plans to reach long-term goals. The Alternative Payment Methodologies Committee is focused on shifting from the old fee-for-service model to payments based on quality and value rather than volume; and the Primary care Transformation Advisory Committee deals with supporting the development of primary care infrastructure and coordinated, high-quality, patient-centered care.

As is usually the case in the Rhode Island health policy world, these advisory committees featured a diverse group of stakeholders. Representatives from the carriers, provider and hospital groups, the employer community, and consumer advocacy organizations were at the table. With support from OHIC staff, they crafted the plans announced yesterday which will guide commercial payers for the next year. Both committees will reconvene in the Fall.

[Read OHIC’s Press Release]