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Overview of OHIC’s Care Transformation & Payment Reform Initiatives. Kathleen C. Hittner, MD. Health Insurance Commissioner November 12 th , 2015. Agenda. Policy Objectives of the Affordability Standards Strategy 1: Care Transformation Strategy 2: Payment Reform Questions.
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Overview of OHIC’s Care Transformation & Payment Reform Initiatives Kathleen C. Hittner, MD. Health Insurance Commissioner November 12th, 2015
Agenda • Policy Objectives of the Affordability Standards • Strategy 1: Care Transformation • Strategy 2: Payment Reform • Questions
Policy Objectives • The key objective of OHIC’s Affordability Standards is to make health insurance coverage more affordable for Rhode Islanders by driving increased efficiency and quality in medical care delivery. • Two mutually reinforcing strategies to achieve this objective are to transform the way care is delivered and reform how care is reimbursed.
Care Transformation • Initiatives to foster a delivery system capable of managing population health and total cost of care. • Strengthen primary care. • Expand PCMH to reach 80% of primary care providers by 2019. • Reduce barriers to practice transformation. • Build connections between primary care, specialists, hospitals and post-acute care providers. • Make data and analytics accessible and actionable. Transforming the Delivery System
Payment Reform Paying for Value, Not Volume • Initiatives to align health care payment with incentives for efficiency and quality of care. • Drive health care payment to alternative payment models that evaluate provider performance on cost and quality. • Convene stakeholders to plan strategies and develop recommendations around expansion of alternative payment models.
THE AFFORDABILITY STANDARDS Outcomes First Wave: 2009 -2014 Second Wave: 2015 -2019 Anticipated Outcomes Goals • Systemic payment reform. • Stronger incentives for cost efficiency and quality in provider reimbursement contracts. • Less waste and duplication. Paying for Value, not Volume. • Premium increases in line with core inflation. • More innovative and efficient health care system. • Improved access to services through greater affordability. • Healthier population. • Improved climate for doing business in Rhode Island. • Value-based contracting with hospitals. • Unprecedented focus on quality performance targets. • Fee increases at risk for quality performance. • Year by year targets for use of alternative payment models by commercial payers. • Required quality incentive program. • Fee increases tied to quality. Transforming the Delivery System • Primary care spend increased from 5.5% to 10.6% of spend. • Significant growth in PCMH & HIT. • Improved ability of medical homes to manage high risk and rising risk patients. • Greater coordination of care across the system. • Increased financial support for primary care. • Patient-centered medical homes. • EHR incentives and CurrentCare • Enhanced Patient-centered medical home standards. • Accountable Care Organizations. Controlling Cost • Greater leverage for insurers to negotiate reasonable rate of increase of hospital fees. • Hospital fee increases aligned with core inflation by 2019. • More aggressive price increase limitation for hospitals. • Budget increase limitation for ACOs. • Price increase limitation for hospitals. • Growth tied to CMS Price Index
