OHIC expands quality-based payment model requirements

CRANSTON – The state’s health insurance regulator on Thursday announced new policies designed to further change how commercial health insurers pay for care.
The initiatives require that Rhode Island commercial insurers use health care payment models focused on “quality, rather than volume,” according to a press release from R.I. Office of Health Insurance Commissioner.
“The Office of the Health Insurance Commissioner continues to advance policies designed to meaningfully improve the quality and efficiency of health care service delivery in Rhode Island,” OHIC Commissioner Dr. Kathleen C. Hittner said in a prepared statement.
OHIC’s first initiative, the new Alternative Payment Methodology Plan, builds off a previous set of standards from July 2015. Rhode Island commercial health insurers beginning in 2017 will be required to direct 40 percent of medical payments through quality and efficiency-based payment models. The requirement increases to 50 percent in 2018.
A second initiative, called the Care Transformation Plan, requires commercial insurers to continue to grow primary care patient-centered medical homes. The regulator says it’s providing guidelines on how to continue this work, according to a press release.
“We are highly appreciative of the time, effort and input that physicians, payers, employers and consumers have committed as we developed these affordability initiatives,” Hittner said.
The new initiatives are meant to build off efforts of Gov. Gina M. Raimondo, who last year pushed to redesign the state’s Medicaid program.
“The new initiatives adopted by OHIC, along with the Raimondo administration’s efforts to innovate health care, signify a major step in the transitioning to health care payments based on value and expanding models of care delivery that stress care coordination and increase quality of care,” according to the release.
Rhode Island insurers are expected to meet the new standards during the regulator’s annual rate review later this year.

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