Reform and Policy Work
The Office of the Health Insurance Commissioner takes a leadership role in state healthcare reform. OHIC works with stakeholders on policies aimed to help make sure the health care system is meeting Rhode Island's needs. OHIC gathers input from a range of stakeholders to ensure that proposed system reforms are practical, relevant, and fair.
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 January, 2017.
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
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
OHIC is working with a range of partners on a new research tool: a database of health insurance payments and claims. The All-Payer Claims Database (APCD) brings together data from Medicare, Medicaid, and all major health insurance companies operating in Rhode Island to give a much clearer picture of RI’s health care system. Learn more about the All-Payer Claims Data Base (APCD)
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 Health Care Planning and Accountability Advisory Council (HCPAAC) was formed by the General Assembly to create plans to improve Rhode Island's healthcare system. HCPAAC makes recommendations to the Governor and General Assembly. Learn more about the Health Care Planning and Accountability Advisory Council (HCPAAC)
Rhode Island Health Insurance Enforcement & Consumer Protection Cycle 1 Grant
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:
- Non-discrimination under comprehensive health insurance coverage,
- Coverage of preventive health services,
- Appeals process, and
- Parity in mental health and substance use disorder benefits.
Specifically, for each of the above-referenced focus areas, OHIC will:
- Collect data and information to establish a baseline;
- 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;
- Issue guidance to issuers and/or implement activities to ensure compliance with all market reform activities; and
- 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.
Health care administration can be complex – and could lead to increases in costs. OHIC’s Administrative Simplification Task Force was formed by the General Assembly to create a way that health care stakeholders can agree on changes that make the system more efficient and effective. The Task Force aims to save hospitals, providers, consumers, and insurers both time and money.Administrative Simplification Workgroup Summary May 2013 Administrative Simplification Report March 2014
Healthy Rhode Island – State Innovation Model (SIM) Grant
OHIC is part of a strong interagency team focused on significantly reforming Rhode Island’s health care system. The Affordable Care Act created the State Innovation Model grant program to ensure that states could “improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries – and for all residents of participating states.” Rhode Island has received a $20 million award to test our health care payment and service delivery reform model over the next four years, in a project called Healthy Rhode Island.
In its vision statement, Healthy Rhode Island states that it aims to achieve measurable improvement in health and productivity of all Rhode Islanders, and achieve better care while decreasing the overall cost of care. We plan to transition from a disparate and health care provider and payer-centric environment to an organized delivery and payment system that is outcomes-oriented and person-centric.
Healthy Rhode Island will create a “value-based care” paradigm, focused on patient care quality measurements and strategies for engaging patients in their own health care. Health Insurance Commissioner Kathleen C Hittner serves on the diverse community-based steering committee and OHIC staff members are key participants in the internal working group of state staff tasked with implementing the project. Learn more about SIM