Related Experiment Videos
Using insurance standards and policy levers to build a high performance health system
Michael Bailit1, Christopher Koller
1Bailit Health Purchasing, LLC, USA. mbailit@bailit-health.com
Issue Brief (Commonwealth Fund)
|July 10, 2010
Summary
Rhode Island
Area of Science:
- Health Policy and Management
- Health Insurance Regulation
- Healthcare Reform
Background:
- State health insurance regulatory authority is being used in unprecedented ways to drive health system reform.
- The Rhode Island Office of the Health Insurance Commissioner (OHIC) was established in 2004 with unique regulatory powers.
- OHIC is mandated to guide insurers toward policies enhancing health system accessibility, quality, and affordability.
Purpose of the Study:
- To examine Rhode Island's innovative use of state insurance regulatory authority for health system transformation.
- To analyze the implementation of OHIC's 2009 standards aimed at improving healthcare affordability.
- To assess the potential of state insurance regulation to foster significant changes in healthcare delivery.
Main Methods:
- Analysis of Rhode Island's legislative actions establishing OHIC's regulatory authority.
- Review of OHIC's 2009 implemented standards for health insurers.
- Examination of requirements for increased primary care investment, medical home expansion, and electronic medical record adoption.
Main Results:
- Rhode Island's OHIC utilized its regulatory authority to implement affordability standards in 2009.
- Insurers are now required to boost primary care investment, adopt the chronic care model medical home, and support electronic medical records.
- These measures represent a novel approach to leveraging state insurance regulation for systemic healthcare improvement.
Conclusions:
- State insurance regulatory authority can be a powerful tool for driving health system reform.
- Rhode Island's initiative demonstrates a proactive strategy to enhance healthcare affordability and delivery through insurance regulation.
- The findings suggest that similar regulatory approaches could be explored in other states seeking healthcare transformation.
Related Concept Videos
01:18Introduction To Health Care Delivery System
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:20Integrated Healthcare System
An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
01:30Health Information Technology and Healthcare Information System
Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:26Methods Of Healthcare Delivery System
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:11Secondary Healthcare System
Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
01:29Issues And Trends In Healthcare Delivery System
The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...