Koller: ‘We are no longer talking past one another’

WORKING THROUGH IT: Outgoing R.I. Health Insurance Commissioner Christopher F. Koller, pictured speaking, says that in a year, the transition of Affordable Care Act implementation will give way to a “more stable” environment. / PBN FILE PHOTO/RUPERT WHITELEY
WORKING THROUGH IT: Outgoing R.I. Health Insurance Commissioner Christopher F. Koller, pictured speaking, says that in a year, the transition of Affordable Care Act implementation will give way to a “more stable” environment. / PBN FILE PHOTO/RUPERT WHITELEY

R.I. Health Insurance Commissioner Christopher F. Koller says there’s enough unfinished business to keep him working right up until the last minute of his scheduled departure at the end of June. That’s when he’s set to begin his new job as president of the Milbank Memorial Fund in New York City.
Appointed in 2005 as the nation’s first-ever health-insurance commissioner, Koller has blazed a trail of innovation during his eight-year tenure, often challenging the state’s dominant health care insurers and hospital networks to change the way they do business.
Koller successfully championed the 2010 affordability standards in contracts between health insurers and hospitals. He helped to spur innovations in health care delivery models, such as introducing the patient-centered medical home as part of the creation of the Rhode Island Chronic Care Sustainability Initiative. And he successfully withstood a lawsuit challenging his authority to review contracts between hospitals and insurers.
Koller has a lot on his plate before he leaves: The new insurance products on the R.I. Health Benefits Exchange will be debuted; he is scheduled to rule on the proposed rate increases requested by the three commercial health insurers and the report he co-chaired about hospital capacity will be addressed by the General Assembly.

PBN: What is the status of the final report on hospital capacity by the statewide Health Care Planning and Accountability Council?
KOLLER: The council approved a final version of the report, which we will be sending over to the legislature shortly. [It was sent on April 30.] … They are facts, findings, conclusions – not recommendations.
What’s going to happen next depends on the policymakers. One of the findings was that in five years, there would be 200 extra hospital beds. The findings were agreed to by a pretty diverse group of prominent folks, including hospitals.

PBN: The Rhode Island Chronic Care Sustainability Initiative recently announced its plan to expand next year to cover about 200,000 Rhode Islanders as part of its patient-centered medical-home network. Future expansion is slated to go to 500,000? Who is paying for that expansion?
KOLLER: There are the medical costs, and the administrative costs. The medical costs are much more significant. I don’t want to speak for the health plans. The insurers [Blue Cross & Blue Shield of Rhode Island, UnitedHealthcare of New England and Tufts Health Plan] have made the decision to expand. … Whether it’s 500,000 patients or the next 100,000 patients, it’s an investment and a decision about whether it’s worthwhile.
There’s a reason why we didn’t choose to go with the bigger number [500,000] tomorrow. I believe it is worth it to expand the practices. Think of this as an investment in the [health care] delivery system that can generate savings.

PBN: How has the nature of the conversation between hospitals, insurers and your office changed? Is there less conflict and more collaboration?
KOLLER: I think we’re further down the road. As we get more experience [with collaboration], we are no longer talking past one another on the underlying issues.
I would attribute this to two things – the arrival of Gov. Lincoln D. Chafee and the appointment of Lt. Gov. Elizabeth H. Roberts as the chair of the R.I. Healthcare Reform Commission, and the passage of the Affordable Care Act, which really defines the parameters of our work at the state level, providing priorities and a framework.
Here in Rhode Island, the governor has brought about a pretty significant interagency coordination, bringing a lot of stakeholders to the table.

PBN: Have you been able to quantify the impacts of the affordability standards on new contracts? KOLLER: The only place in regard to affordability that we’ve seen specific changes in performance have been for the CSI project, which point to improvements in some of the utilization measures.
There are four parts to the affordability standards. We are spending more money on primary care in Rhode Island than we have in the past. There is no evidence that we have changed outcomes in Rhode Island. I wouldn’t expect to see that.
The affordability standards have helped to change the focus of hospital and insurer contracts to move away from the traditional fee for service, to start to talk about pay for performance, ultimately changing the unit of payment to population of care rather than episode of care.
We anticipate releasing in June a third-party evaluation of the affordability standards. … When the affordability standards started, hospital price increases were 6 – 8 percent, with utilization on top of that.
Accountability and transparency, good health planning and hospital leadership have changed that.

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PBN: Blue Cross President and CEO Peter Andruszkiewicz has warned of higher rates for insurance products in part because of the Affordable Care Act. Do you think he was accurate?
KOLLER: We have found it difficult to talk about average overall rate increases when what many employers experience varies a lot from that. Those changes are going to be greater this year, but they will be a lot less than in other states.
All of us involved – insurers, regulators, the exchange – we are all working to understand the impacts of the Affordable Care Act and reduce levels of uncertainty. We are going through a difficult transition, and in a year from now, we’re going to be in a much more stable environment. And it’s a lot more stable here [now] than in other places. •

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