Rhode Island's health insurance commissioner revamps 'affordability standards'

In yet another sign that the state is trying to drive down health care costs by bolstering primary care and restructuring how insurers reimburse medical providers, the state health insurance commissioner has announced the overhaul of the office's so-called "affordability standards."

The revised standards require insurers to increase the percentage of their primary care network operating as "patient-centered medical homes" by 5 percentage points in 2016. By 2019, 80 percent of an insurer's primary care clinicians should be practicing in these medical homes. 

A medical home emphasizes a coordinated team approach to primary care that focuses on a patient's needs and the efficient delivery of services. They are seen as a way to improve the quality of care while realizing savings by preventing illness and disease.

The standards also establish a target of at least 30 percent of insurer medical payments to be made outside of the traditional fee-for-service model. Paying medical providers for each service they provide creates an incentive for high volumes of medical care, which is seen as a major factor in what's driving up the cost of health care.

"My office is committed to holding premiums in check through our annual rate-review process and directing insurers toward practices that change the fundamental factors underlying high medical expense growth rates," Commissioner Kathleen Hittner said in a statement. The new standards "will address those fundamentals by rewarding cost efficiency and quality, instead of volume, and further enhancing primary care’s ability to manage population health and total cost of care."

The changes to the office's affordability standards, which were first instituted in 2010, reflect similar efforts around the country to address the cost of health care.

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