Measure Alignment

A common feature of many contracts between insurers and providers is quality. Insurers often provide financial incentives to providers for meeting targets or demonstrating improvement on a set of quality measures, as a way of encouraging high quality health care. However, when providers have to report their data to multiple insurers who each use a distinct set of measures, it creates an administrative burden. In order to relieve that reporting burden, Rhode Island undertook a statewide Measure Alignment effort to agree upon a common set of quality measures.

In 2015, the Rhode Island State Innovation Model (SIM) Test Grant supported the initial Measure Alignment process by convening a work group composed of stakeholders representing insurers, providers, and consumers to create the first Aligned Measure Sets for use in primary care, ACO, and hospital contracts. The work group met again in 2016 to review the measure sets and develop additional measure sets for Behavioral Health and Maternity. In 2017, the Measure Alignment function transitioned to OHIC after 230-RICR-20-30-4 (Powers and Duties of OHIC) was updated to require that all commercial payers use the Aligned Measure Sets in any contract with a financial incentive tied to quality. Under this regulation, OHIC is responsible for convening the work group annually to review quality measures and make changes to the Aligned Measure Sets as necessary. For more information or if you have any questions, please contact Cory King.