INVESTING IN PRIMARY CARE A RHODE ISLAND CASE STUDY CORY KING - - PowerPoint PPT Presentation

INVESTING IN PRIMARY CARE

A RHODE ISLAND CASE STUDY CORY KING DIRECTOR OF POLICY RHODE ISLAND OFFICE OF THE HEALTH INSURANCE COMMISSIONER

ABOUT OHIC

The Office of the Health Insurance Commissioner (OHIC) was created by the Rhode Island General Assembly in 2004. The agency is charged with protecting consumers, ensuring fair treatment of health care providers, guarding the solvency of insurers, and improving the health care system as a whole.

RIGL 42-14.5-2

2

BACKGROUND ON THE AFFORDABILITY STANDARDS

¡ The Affordability Standards comprise a set of requirements for health

insurers to follow in their efforts to improve the affordability of their products.

¡ The Affordability Standards are also designed to promote other aspects

• f OHIC’s mission, including consumer protection, access to care, and

health care quality.

3

THE RATIONALE FOR PRIMARY CARE INVESTMENT

4

Address underinvestment in Rhode Island compared to high performing health systems. Develop a policy lever to drive transformation of primary care and establish a foundation for broader system changes. Pursue an opportunity to improve system performance on cost, quality and access.

CONSIDERATIONS FOR POLICY DESIGN

5

Define what constitutes spending

• n primary care.

Measure your baseline and compare to external benchmarks. Articulate the

• utcomes you want

to achieve. Confirm policy goals with stakeholders and specify mechanisms for investment.

THE AFFORDABILITY STANDARDS: FIRST WAVE (2010)

6

MANDATED INCREASED INVESTMENTS IN PRIMARY CARE THROUGH ANNUAL INSURER SPENDING TARGETS. PARTICIPATION IN RHODE ISLAND’S MULTI- PAYER PATIENT

• CENTERED MEDICAL

HOME PROGRAM. FUNDING FOR CURENTCARE, RHODE ISLAND’S HEALTH INFORMATION EXCHANGE. PRICE CONTROLS, MANDATED SHIFT TO DRGS, AND QUALITY INCENTIVE PROGRAMS FOR HOSPITALS.

PRIMARY CARE INVESTMENT

7 5.7% 6.3% 7.1% 8.0% 9.1% 9.8% 10.5% 11.5% 11.6% 11.5% 12.3% 12.5%

$- $10 $20 $30 $40 $50 $60 $70 $80 $90

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Forecast

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%

Millions

Primary Care Spending as Percent of Total Medical Spending

Primary Care Spending, Total and as Percent of Total Medical Spending 2008 - 2019

Total Primary Care Primary Care % of Total Medical

EMPHASIS ON NON-FFS INVESTMENTS

8 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Forecast BCB SRI 8.8% 13.5% 23.6% 29.0% 39.6% 40.1% 46.7% 53.2% 51.3% 56.3% 57.8% 57.2% UHC 2.0% 5.9% 13.9% 23.8% 33.0% 42.0% 54.6% 56.4% 51.2% 50.0% 59.0% 54.4% THP 6.0% 12.2% 12.5% 12.2% 17.0% 25.5% 33.6% 41.3% 69.0% 69.5% 75.0% NHP 0.1% 11.0% 9.6% 17.7% 14.2%

4.0% 14.0% 24.0% 34.0% 44.0% 54.0% 64.0% 74.0% 84.0% Percent of T

• tal Primary Care Spending

Percent of Primary Care Spending Dedicated to Non-FFS Investments by Insurer 2008 - 2019

BENDING THE COST CURVE

Source: Baum, A., Song, Z., Landon, B., Phillips, R., Bitton, A., Basu, S. (2019). Health Care Spending Slowed After Rhode Island Applied Affordability Standards to Commercial Insurers. Health Affairs, 38(2), 237-245. https://doi.org/10.1377/hlthaff.2018.05164

9

WHERE DOES PRIMARY CARE INVESTMENT GET US?

10

Investment standards have promoted multi-payer collaboration on practice transformation and a focus on cost and quality. The number of PCMHs increased from 0 in 2008 to 186 in 2020 and about 65% of primary care clinicians are practicing in a PCMH. Primary care investment lays the foundation for more systemic innovations (ACOs, risk-based contracting).

PAYMENT REFORM UNDER THE AFFORDABILITY STANDARDS

11 $- $100 $200 $300 $400 $500 $600 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% 2014A 2015A 2016A 2017A Millions

DOLLARS PAID UNDER APMS AND APM DOLLARS AS PERCENT OF TOTAL MEDICAL SPENDING 2014 - 2017

Total Dollars Paid Under APMs APM Percent

TRANSITION TO RISK-BASED CONTRACTS

12

$204 $219 $305 $62 $3 $6 $137 $404

$- $50 $100 $150 $200 $250 $300 $350 $400 $450 2014A 2015A 2016A 2017A Millions

DISTRIBUTION OF POPULATION-BASED CONTRACT CLAIMS PAYMENTS IN UPSIDE-ONLY VS DOWNSIDE RISK MODELS

Upside Gainsharing Only Downside Risk

Note: Payments include allowed claims for all members attributed to providers under population-based contracts and which are subject to the contractual budget target.

LESSONS LEARNED

13

Understand your goals and the logic of change. Include primary care as part of a broader strategy. Don’t overpromise on results. Maintain an openness to course correction. Primary care needs a champion in government.