PROVIDENCE — The Office of Health Insurance Commissioner has issued the 2018 requirements for its Care Transformation and Alternative Payment Methodology Plans, updates intended to continue a move of the state’s health care industry to a value-based system, the agency announced in its January 2018 newsletter.
The 2018 Care Transformation Plan requires 50 percent of practices contracting with insurers that have not been designated Patient-Centered Medical Home to do so by Nov. 30, 2018. By the end of 2019, 90 percent of current contracting practices are required to have attained PCMH status.
Internal Controls & Audits: Keys to a Resilient Hospitality Business
In the fast-paced world of hospitality, where operations run 24 hours a day, 365 days…
Learn More
PCMH centers put the patient at the center of a constellation of doctors and providers who come together in one place to consult about treatment.
The 2018 Alternative Payments Methodologies plan requires medical practices to assume financial risk in the care they provide through risk-based contracts. Practices using these agreements stand to gain or lose money based on the quality of the care they provide and patient outcomes, providing an incentive for higher-value health care. Under the new plan, 10 percent of an insurer’s enrollees should be covered under a risk-based contract by the end of 2018 and 30 percent by the end of 2019.
The plan also sets targets for other types of non-fee-forservice payment models and establishes an overall goal of 50% of insurer payments to be under some kind of alternative method in 2018 and 2019.
Each rule is the latest step in a plan to move the state’s health care system toward one focused on value rather than volume of care, begun in 2010, said Cory King, principal policy associate at OHIC.
“They really build off the provider requirements that we’ve developed over the years,” King said.
The Care Transformation and Alternative Payment Methodology Advisory Committees, each comprised of provider, insurer and consumer representatives, held several public meetings to discuss and develop the plans.
“We must continue to push costs down and improve our overall health,” Commissioner Marie L. Ganim said in announcing the new plans.
Rob Borkowski is a PBN staff writer.
