Home Economy Economic Activity Neronha: OHIC needs to be bolder on efforts to boost primary care

Neronha: OHIC needs to be bolder on efforts to boost primary care

By

Katie Castellani

-

11/19/2024

neronha — ATTORNEY GENERAL Peter F. Neronha believes the Rhode Island Office of the Health Insurance Commissioner can do more when it comes to improving primary care./COURTESY OF PETER F. NERONHA

PROVIDENCE – Attorney General Peter F. Neronha believes the R.I. Office of the Health Insurance Commissioner can do more when it comes to improving primary care. In October, OHIC proposed amendments to its primary care regulations. The amendments come after a reevaluation of OHIC policies in 2023 to support primary care in the state. Upon

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PROVIDENCE – Attorney General Peter F. Neronha believes the R.I. Office of the Health Insurance Commissioner can do more when it comes to improving primary care. In October, OHIC proposed amendments to its primary care regulations. The amendments come after a reevaluation of OHIC policies in 2023 to support primary care in the state. Upon reviewing the data, OHIC has found that primary care availability is crucial to make health care and health insurance more affordable. However, the state has continued to face shortages of primary care providers, which has hampered patients’ access to care. The amendments would require insurance companies to reduce their prior authorizations by 20%. Prior authorization is the assessment of health care service done before a patient gets treated. Through reports and commissions formed to study the topic, OHIC has found that prior authorization contributes to physician burnout. To address this, OHIC says it has committed to reducing prior authorization volumes and other administrative burdens. But Neronha wants OHIC to be more aggressive with prior authorization. Specifically, he called on OHIC to provide an explanation of its choice for 20% reduction in prior authorization instead of a larger one and include “mechanisms for effective enforcement.” Neronha also wants OHIC to ensure any reduction is new, rather than already required by law and enforce existing laws and regulations related to prior authorization. “The burden needs to shift to the insurance companies to produce documents that show why any prior authorization should be required at all…[and] the data required by this proposed regulation should be available to the public for their review and input,” Neronha said in his public comments. “And the starting point for those conversations should be a number chosen by OHIC through data collection and vigorous investigation, not a number most convenient to insurance companies.” The proposed amendments would also require insurers to allocate at least 10% of their payments to primary care. While Neronha agreed insurance companies should be held more accountable, he said the proposal focuses on an investment in the primary care system as a whole. Instead, OHIC should change the proposal to include a requirement that all payors track and report what percentage of the increased investment is paid directly to the provider and what percentage is related to lower administrative burdens on providers. “Year after year, Rhode Islanders are required to pay more and more for their health insurance, and year after year, they see no return on these undue investments,” said Neronha. “Consumers expect that the amount they pay for a product will directly reflect the product’s quality, and health insurance stands in stark contrast to this reasonable assumption. While this proposed amendment by OHIC seeks to pull in the reins on these insurance companies, who continue to line their pockets with the hard-earned money of Rhode Islanders, it doesn’t go far enough. If we are to ever fix our health care system, we must be bold and data driven in our approach to cost, administrative red tape and holding on to our life-saving doctors. Only then can we begin to fix what is clearly broken.” Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.