Update from RI Office of the Health Insurance Commissioner: PCMH Quality Benchmark Modifications

The RI Office of the Health Insurance Commissioner (OHIC) provides primary care practices with the opportunity to submit their quality measure performance data in order to be considered for RI Patient Centered Medical Home (PCMH) designation. OHIC compares practice performance against established clinical quality benchmarks to determine if a practice qualifies for enhanced insurance payments based on demonstrating clinical quality attainment or improvement.

OHIC set the 2020-2021 performance benchmarks assuming COVID-19 would not have as significant an impact on 2020-21 performance as on 2019-2020 performance. When analyzing the 2020-21 performance data, OHIC noted that care patterns had not recovered from the COVID-19 pandemic as quickly as anticipated and has decided to modify the 2020-2021 benchmarks.