Christopher F. Koller came onboard in 2005 as Rhode Island’s – and the nation’s – first and only state health-insurance commissioner.
He came to the job after nine years as CEO of the Neighborhood Health Plan of Rhode Island, a nonprofit payer founded by 13 community health centers when the state’s Medicaid managed-care program, RIte Care, was created.
From his modest outpost in a cluster of state offices in Cranston near the Eleanor Slater Hospital and the state prison, Koller began making the case for health-insurance reform. He started in the area of insurance companies’ rate increases and later injected his authority into the making of contracts between insurers and hospitals, which one commentator called “poking the bear a little bit.”
Koller has been called a “visionary” by a corporate onlooker, and a “rogue operator” by the former head of Care New England, the hospital group, during a two-pronged lawsuit that resulted partly in a draw and partly in a win for the commissioner.
In the area of insurance rates, Koller has kept a tight hold on costs for policyholders by consistently granting smaller-than-requested rate increases, then listened to insurers complain they had no control over rising costs, especially hospital costs.
In 2009, Koller started getting more proactive. He imposed four conditions on insurers: to increase by 1 percent for five years the portion of their medical expenses going to primary care; to support efforts to better oversee the care of patients with chronic illnesses; to push doctors into using electronic medical records for greater coordination of patient care; and to overhaul the payment system, shifting away from payment for volume and toward payment for quality of services. All are considered essential reforms across the country.
In July 2010, Koller waded into lawsuit-infested waters by moving to impose controls on contracts between hospitals and insurers. He granted rate increases of 8.4 percent to 12.3 percent to insurers, but also took the unprecedented step of imposing conditions on future contracts between insurers and hospitals. Among the conditions, he limited increases in future contracts to the federal medical price index, which then ranged from 2.6 percent to 3.6 percent. In doing so, he was forcing insurers to move away from fee-for-service and into payment methods that rewarded efficiency and good patient outcomes. The action was intended to control runaway insurance costs and improve care.
He said he imposed the conditions because insurance rates “are not as affordable as they should be,” partly because of hospital cost increases of up to 14 percent.
In December that year, Care New England filed a lawsuit challenging Koller’s authority to impose such conditions. Soon after, Koller agreed in an out-of-court settlement to waive the conditions, but said they would be enforced on future contracts through a regulatory process. Portions of the lawsuit remained active until October 2011, when a settlement led to Care New England’s dropping its challenge against Koller’s authority.
Also in 2011, Koller’s office obtained $3.7 million in federal money to conduct rate reviews. And he has been a major figure pushing for implementation in Rhode Island of the federal Affordable Care Act.
“Health insurance is expensive because medical care is expensive,” Koller declared. “More affordable rates of increase will not occur until we change the way our medical care is organized and delivered.” •
