Smart Benefits: Bright Future for Primary Care in Rhode Island

Monday, January 20, 2014

Amy Gallagher, GoLocalProv Business/Health Expert

Last week, the Office of the Health Insurance Commissioner (OHIC) released its 2013 report, Primary Care Spending in Rhode Island. The report measures the state’s health insurance companies’ progress toward expanding and improving the primary care infrastructure, one of OHIC's four affordability standards set for the insurers in 2010 that are designed to guide improvements in the state’s delivery system.

Insurers Meeting Targets

The standard requires insurers to increase the share of total medical payments made to primary care. The report, which shows investments in primary care for the years 2007 -2012 as well as projections for 2013-2014, reveals the carriers are doing their part.

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Insurers spent 9.1 cents of every fully insured commercial medial dollar on primary care services in 2012, an increase of nearly 3.5 cents from 2008.
BCBSRI and UnitedHealthcare of New England met or exceed their primary spending targets set for them and are on track to achieve them in 2013 and 2014. While Tufts Health Plan doesn’t have established targets, it spent nearly the same percentage of their medical spending on primary care as the other two carriers.
Insurers continue to invest in non-fee-for-service methods, especially patient-centered medical homes (PCMH), a reorganization of physician practices designed to focus more on better care outcomes and help practices run more efficiently. The carriers are expected to meet OHIC’s requirements of allocating at least 35% of their total primary care spending to non-fee-for-service investments in 2013.
Spending on primary care grew 37% from 2008 to 2012, while total medical spending fell 14%, due to a number of factors: improved care coordination and increased focus on primary care; slower economic recovery in Rhode Island; fewer fully-insured enrollees due to higher adoption of self-funding; and a decreasing population

Projections Promising

Already, the state’s insurers are poised to meet their targets in 2014. And all three are increasing their investment in patient-centered medical homes, which are catching on with big practices like Coastal Medical and University Medicine. As more and more practices adopt the PCMH model, they will continue to be more efficient and drive out added costs, while still improving health outcomes.

As the report reveals an emphasis on primary care is expected to remain at center stage, the future looks a lot healthier for Rhode Islanders.

{image_2}Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.