Affordability Standards

Leading the way in Rhode Island health care reform and serving as a model for other states, the Office of the Health Insurance Commissioner has established a comprehensive set of Affordability Standards to lower costs and improve quality. These standards encourage insurance companies and hospitals to reduce costs by creating more efficient systems, not by lowering the quality of care or reducing coverage.

The first major goal of the Affordability Standards is to improve primary care within the state by requiring insurers to invest more in primary care providers and services and encouraging primary care practices to transform into Patient Centered Medical Homes (PCMHs). A focus on primary care reduces overall costs by helping patients identify potential problems before they become serious. Further, the PCMH system, especially among people with chronic conditions, reduces overall health care costs in Rhode Island as it improves quality of care for the chronically ill.

The second major goal of the Affordability Standards is to reduce costs through the adoption of payment reform strategies. The four key areas of focus in payment reform include: promoting population-based contracting, adoption of alternative payment methodologies, improved hospital contracting practices, and controlling cost increases associated with population-based contracts entered into by Integrated Systems of Care.

Since the Affordability Standards went into effect in 2010, they have had tangible results. Primary care spending has increased by over a third since 2008 and the rate of hospital cost increases has slowed. Together these changes ensure that Rhode Islanders will have more affordable care in the long term.