In Rhode Island, the person often at the center of the storm swirling around health care reform, health insurance rates and improved quality of care is R.I. Health Insurance Commissioner Christopher F. Koller.
Koller, working with his small staff at the R.I. Office of Health Insurance Commissioner, is playing a pivotal role. In July, when he approved rate increases sought by health insurance companies, he added new conditions to be met in future contract extensions between these companies and hospitals to push payment reforms that rewarded outcomes, not volume.
As a result, the new contract renewal reached between Blue Cross and Blue Shield of Rhode Island and Lifespan, the state’s largest hospital system, reflects those changes.
PBN interviewed Koller recently, asking him for his insights into the challenges Rhode Island faces moving forward.
PBN: What are the challenges Rhode Island faces in moving from a consensus of “what needs to be done” to a consensus of “how to do it” to address improvements in the quality, affordability and efficacy in the delivery of health care?
KOLLER: Three challenges define our health and medical goals in terms of the community, and not just the individual. Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services at the Department of Health and Human Services, talks about the triple aim of the health care system.
First, improved health outcomes, system efficiency and patient experience.
Second, learn what works in other communities. There are communities with lower costs and better health. What do they do differently?
Third, civic leadership. We need people who are not part of the medical system – the ones who pay the bills and who are the patients – to be telling the medical system what they need to do to meet those goals.
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PBN: How important a factor is the willingness of primary care providers, the business community, health insurance companies and hospital systems to enter into dialogue and achieve some sense of collaboration moving forward?
KOLLER: It is very important to have dialogue and collaboration among all the players in the health care system. But it has to be in service of the overall goals identified above. A reform where nobody changes – or everybody asks others to change – is not reform.
PBN: Your current office appears to be minimally staffed. Are there more tangible results you might be able to achieve if you had more resources?
KOLLER: The R.I. Office of Health Insurance Commissioner has three FTEs, grant funding secured for another three, and coordinates some services with our partners at the R.I. Division of Business Regulation.
Our budget is about $600,000; we regulate the $3 billion commercial insurance industry.
I am very proud of the work my staff and DBR do. But our consumer protection and market oversight resources are inadequate, especially as health reform comes on line. If we want to have oversight of the industry, to protect consumers and improve the system, we have to allocate resources wisely to meet these goals.
PBN: What are the most critical factors to make health insurance more affordable in Rhode Island?
KOLLER: Making health insurance more affordable is no small task. Many people think just having more insurers competing will reduce costs. There is no evidence to support this – our average premiums in Rhode Island are actually cheaper than our neighbors. [In order] to meet Dr. Berwick’s triple aim, many people are working in Rhode Island to promote prevention, to put excellent primary care at the center of the delivery system, to change the way providers are paid, to measure how we are doing and to put in place policies and benefit designs that help people stay healthy
PBN: One in five Medicare patients is readmitted to a hospital within 30 days of discharge. What kinds of policy changes could improve this trend, which represents a significant drain of resources?
KOLLER: Yes, about one-fifth of Medicare patients discharged from a hospital in Rhode Island are readmitted within 30 days. This is dangerous and expensive.
There is much exciting work being done in Rhode Island to improve this performance. Led by Rhode Island Quality Partners, hospitals and doctors are defining what has to occur to help patients have a “safe transition” from hospital to home to reduce readmissions.
My office is requiring health plans and hospitals to put theses standards in contracts. We are helping primary physicians have more resources to improve care coordination for these folks.
Lastly we have started to have a conversation with health plans and hospitals to change the payment rules, so when people are discharged and get back to full activity, it is a win for the hospital as well as the patient.
