Important update from the Office of the Health Insurance Commissioner

OHIC continues to focus on implementing initiatives to promote primary care, including through patient-centered medical homes (PCMHs). OHIC requires commercial health plans to provide supplemental payments to primary care practices that meet OHIC’s three-part definition of PCMH to help finance their PCMH operations. The three-part definition includes requirements related to:

1.   A practice’s level of transformation experience;

2.   Implementation of a quality improvement strategy targeted at cost management, and

3.   Demonstration of meaningful performance improvement. 

Practices interested in applying for recognition by OHIC must submit practice reports by October 17.

Starting in 2022, practices affiliated with an ACO/AE do not have to submit quality measure data. These practices are being held accountable for quality performance and cost of care under existing ACO/AE contracts. OHIC hopes that this will decrease the administrative burden on practices from having to report measures to OHIC separately. OHIC will still need these practices to submit basic information on the practice, NCQA designation, and answer the integrated behavioral health survey questions.

Documentation, including links to the practice surveys, quality benchmarks, and measure specifications, are located on the OHIC website. If you are reporting for 5 or more practices and wish to submit using an excel spreadsheet, the spreadsheet templates can also be downloaded from the OHIC PCMH webpage and submitted via email. Questions? Contact Cory King (401-462-9658 or cory.king@ohic.ri.gov).