Smart Benefits: New OHIC Standards to Improve Health Care Delivery

Rob Calise, GoLocalProv Business/Health Expert

Smart Benefits: New OHIC Standards to Improve Health Care Delivery

Last week, Rhode Island’s Health Insurance Commissioner adopted standards to expand health care payment methods that reward efficiency and quality rather than volume and boost the percentage of insurer-contracted primary care practices operating as patient-centered medical homes.

The standards follow the recommended plans of two OHIC advisory committees convened in March of this year.

•    Payment Reform: The Alternative Payment Methodology Plan establishes payment reform targets for commercial insurers to increase the use of payments that emphasize value rather than volume and include efficiency-based global and bundled payment models, as well as payments based on quality performance. It also sets a target for at least 30% of insured medical payments to be made through an alternative payment model by 2016. 

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•    PCMH Investments: Under the Care Transformation Plan, insurers must increase the percentage of their primary care network functioning as a PCMH by 5 percentage points for 2016 and sets a target of 80% of Rhode Island primary care clinicians practicing in a PCMH by 2019. 

Designed to move to health care payments based on value and increase models of care delivery that emphasize coordination and increase quality, the office says the new standards should produce more affordable health insurance premiums in the future.

Rob Calise is a founding partner of Cornerstone Group, where he helps clients control the costs of employee benefits by focusing on consumer driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance.

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