Insurers Spending More On Primary Care

Feb 4, 2014

News from the state's health insurance commissioner (OHIC): insurers are making good on their commitment to invest more of their premium revenue in primary care. OHIC directed insurers to raise the amount they spend on their members' primary care by one percentage point every year for four years. And in a new report the agency says they're going to hit those targets.

In addition to the primary care spending requirements, OHIC instituted some other standards for health insurers to live up to in Rhode Island that are supposed to lower health care costs overall while boosting the quality of care. Here's how OHIC describes the so-called "affordability standards:"

The Affordability Standards
Begun in 2010, the Affordability Standards ensure health plans invest their premium dollars in structural improvements to the healthcare system. OHIC directs commercial health insurers to:

1. Expand and improve the primary care infrastructure
2. Spread the adoption of patient-centered medical homes
3. Support CurrentCare, the state’s health information exchange
4. Work toward comprehensive payment reform across the health care system

So what do these standards look like in action - for you, or me, or anyone else in the health care system in Rhode Island? Well, it might mean your primary care doctor can afford to hire a nurse case manager, or is using electronic medical records to better coordinate your care. It might mean you're in a patient-centered medical home, which means a team of health care providers manages your care, as opposed to a single primary care doctor here, a separate specialist there, etc. For doctors, it might mean you're getting a financial reward for enrolling a certain number of patients in the state's electronic medical records system, CurrentCare. Or that the insurers you contract with are moving (slowly) away from paying you a fee for every service and procedure and toward paying you for managing a patient's overall health or certain condition.

Does it mean your health care is cheaper? Not necessarily, or not yet. But it may be one way to get there.