Implementing The Federal Health Law In Rhode Island: More Than Insurance Access

Rhode Island has a long tradition of health policy innovation. The state’s ambitious health agenda, under the leadership of Gov. Lincoln Chafee, focuses not only on insurance access but on improving the value of medical care in the state. The Affordable Care Act provides invaluable tools and blueprints for motivated states – like Rhode Island – to construct what works for their communities.

Implementing The Federal Health Law In Rhode Island: More Than Insurance Access

Christopher F. Koller

After taking office in January 2011, Gov. Chafee, an Independent, established Rhode Island’s Health Care Reform Commission. Chaired by Lt. Gov. Elizabeth Roberts, the commission consists of more than 100 community and healthcare stakeholders and is overseen by an executive committee consisting of the chair, the three Cabinet officials with health care oversight responsibilities and the governor’s policy director. Consistent with the enormous opportunities for states presented by the health law, this panel has established four priority areas of work.

Expanding Access
Building on RIte Care – the state’s nationally recognized Medicaid managed care program – and an aggressively overseen commercial insurance market, Rhode Island has embraced the direction and resources provided by the health law.

After initial federal planning grant funds were awarded, the state legislature failed to approve measures to establish a state-based insurance exchange because of disagreements over abortion policies. But last July, the governor issued an executive order creating Rhode Island’s exchange as a division of his office.
With this direction, the state was the first in the country to obtain its full share of federal funding to establish its exchange and has commenced planning and implementation efforts. The commission and the governor envision the exchange as a means to change the experience of health insurance purchasing in Rhode Island for individuals and small businesses – a single marketplace where they can understand their insurance options and available subsidies and select the products that best meet their needs and budgets.

More On State Health Exchanges

Read about other states’ efforts to create health exchanges:

To implement this vision, a citizen-led advisory board has been put in place. Supporting this panel and incoming exchange staff, an interagency planning and implementation group has been established with an unprecedented level of coordination. With six participating agencies, and funding coming from a number of sources including the Medicaid program, the group is now designing a new enrollment and eligibility process for Medicaid, the exchange and the state’s social services program. It is also procuring the information system to support it.

Like others, Rhode Island eagerly awaits the upcoming Supreme Court decision but remains committed to reforming the health insurance market with this exchange no matter what the court rules. The need for a well-regulated, well-understood and fairly priced market where individuals can buy insurance – as envisioned by the exchange – will only grow. While our state is committed to using federal funding to develop an exchange, regardless of the status of an individual mandate, the health law’s financial support — provided in the form of the Medicaid expansion and the subsidies for those with incomes above Medicaid eligibility levels — is critical to states and providers wrestling with the challenges and inequities of uninsured populations.

Supporting Payment And Delivery System Reform
To succeed, reform must improve the value of health care — not just its accessibility. The executive committee and Health Care Reform Commission have been working to develop policies to improve Rhode Island’s delivery system. Commercial insurers — with the facilitation of my office — are changing the way they pay hospitals to reduce dependence on fee-for-services systems and align with Medicare. Medicaid is working with its managed care organizations to limit rate increases. Aggressive commercial insurance rate review is already in place and caps on increases are being considered as a way to create pressure for delivery system reform. Finally, with two of the state’s 11 hospitals in financial receivership and medical care the largest industry in a state with high rates of unemployment, hard choices about delivery system investments must be informed by reliable data, civic leadership and a public planning process.

Build Primary Care And Home And Community Care Workforce
Efforts to improve the delivery of care must stand on a robust primary care infrastructure. Led by public and private efforts, Rhode Island has more accredited patient-centered medical homes per capita than any other state. As health insurance commissioner, I have directed commercial insurers to increase their investments in primary care as a condition of rate approval. In addition, Medicaid is engaged in numerous initiatives to reduce its enrollees’ use of unnecessary nursing home care, our local Quality Improvement Organization is leading an effort to improve transitions of care for patients leaving hospitals and a commission task force is working to increase the number of graduates trained for this new work.

Building The Capacity For Reform In The State
To improve the value of medical care, information and data must be used more effectively for treatment and policy decisions. The Rhode Island Quality Institute has led a public/private effort to improve the state’s health Information technology infrastructure with a strategy that promotes adoption of electronic medical records, the sharing of that information through a common health information exchange, and the measurement of performance and quality using that information. Employer engagement and a broad ongoing funding base are critical to these efforts. In addition, the state is using federal funds to develop an all payer claim database and present unified analyses of system performance.

The federal health law provides enormous resources — financial and policy — to states committed to working on both medical care access and medical care value. This commitment exists in Rhode Island. The work is not easy — particularly engaging a public that can be overwhelmed by the complexity of our would-be “system” and employers simply struggling to pay for workers’ insurance. The ACA’s “toolbox” and the Health Care Reform Commission’s structure and work offers great promise in the Ocean State.

Christopher F. Koller is the health insurance commissioner of the state of Rhode Island.