Policy Reform

Leveraging the regulatory structure within OHIC to accelerate delivery system reform

The office is focused on improving the health care delivery system in the state to improve affordability, quality, and health equity for all Rhode Islanders. OHIC is supporting delivery system reform by encouraging provider payment models that improve value, fostering primary care transformation, and advising on the impact of hospital consolidation. The goal is to leverage the regulatory structure within OHIC to accelerate the transition to a reformed delivery system where provider organizations are incentivized to deliver accessible, affordable, and high-quality care that produces improved health outcomes.

OHIC is committed to making RI's healthcare system more affordable and easier to use. That's why OHIC has set standards that will support primary care, transform healthcare delivery, and change the way we pay for care. Learn more about Affordability Standards, updated June, 2020.

Standing at the forefront of Rhode Island primary care practice transformation in RI, the Care Transformation Collaborative (formerly the R.I. Chronic Care Sustainability Initiative, or CSI-RI) is an all-payer program that promotes care for patients through the patient-centered medical home (PCMH) model. Learn more about CTC-RI

The State of Rhode Island is working with the Brown University School of Public Health and the Peterson Center on Healthcare on a data-driven healthcare cost trend analysis to develop an annual healthcare cost growth target, and inform system performance improvements. Learn more about the Health Care Cost Trends Project here.

OHIC staff and consultants produce regular reports on the latest trends and developments in the health care market. Learn more about OHIC Health policy Reports and Data Analysis

In an effort to reduce administrative burden and improve the quality of health care in Rhode Island, OHIC works with a diverse set of stakeholders to review aligned quality measure sets that insurers are required to use in contracts that have a financial incentive tied to quality. Learn more about Measure Alignment.

The State of Rhode Island Office of the Health Insurance Commissioner (OHIC) has a comprehensive, innovative, and transparent form and rate review process, focused on protecting consumers. OHIC has used its statutory authority to view the healthcare system as a comprehensive entity and to affect value and transparency in the health care system. Over the last few years, OHIC has received several cycles of Rate Review Grant funds to strengthen its rate review process by focusing on improving the rigor and transparency of the process while tying in delivery and payment system reform initiatives.

Through the Health Insurance Enforcement and Consumer Protection Cycle I Grant, OHIC is proposing to use funds to enhance and improve the form review process by supporting work in four market reform areas:

  1. Non-discrimination under comprehensive health insurance coverage,
  2. Coverage of preventive health services,
  3. Appeals process, and
  4. Parity in mental health and substance use disorder benefits.

Specifically, for each of the above-referenced focus areas, OHIC will:

  1. Collect data and information to establish a baseline;
  2. Use/refine existing tools or create new tools, as appropriate, to assist in the review of plan benefit documents (forms). This includes using these tools to determine compliance;
  3. Issue guidance to issuers and/or implement activities to ensure compliance with all market reform activities; and
  4. Incorporate all findings into the annual form review process while continually revisiting tools/templates for necessary modifications and updates to meet state and federal requirements.

To accomplish these improvements in the form review process under the four market reform areas, OHIC requested and was granted $1,090,263.35 from the Health Insurance Enforcement and Consumer Protection Cycle I Grant.

OHIC’s current form review process gives us a solid foundation upon which to build, enhance, and improve enforcement and consumer protection activities. Health Insurance Enforcement and Consumer Protection Grant funding will allow OHIC to more effectively ensure that our laws, regulations, and procedures are in line with federal requirements and allow us to more effectively oversee and enforce the specified market reform provisions. OHIC remains committed to its partnership with HHS and, as such, will continue to serve as a valuable model for other states also engaged in the form review process.

More information on the PCMH definition and provider reporting requirements can be found here