For Immediate Release - March 12, 2013

Division of Insurance, Health Policy Commission to Focus on Key Health Care Cost Containment Strategies

Upcoming sessions on provider organizations tied to Ch. 224, transparency on provider organizations and transition from fee-for-service to alternative payment methods

BOSTON – Tuesday, March 12, 2013 – The Division of Insurance (DOI) and Health Policy Commission (HPC) will focus on key payment reform and transparency goals of the Commonwealth’s nation-leading health care cost containment law in special sessions on provider organizations set to kick off this week.  Chapter 224, signed by Governor Patrick in August, encourages providers to transition away from fee-for-service payments to alternative payment methods.  Each agency holds a different responsibility for governing these types of organizations. The HPC must establish a registration process for provider organizations and DOI is responsible for certifying provider organizations that accept risk-based payments.  Three public sessions will give providers, insurers and consumers the opportunity to offer input as both agencies develop these important new rules.

“Risk-Bearing Provider Organizations will have reaching effects through the implementation of coordinated care,” said Undersecretary of Consumer Affairs and Business Regulation, Barbara Anthony. “These sessions will be integral in shaping the Division’s policy and we look forward to hearing from stakeholders as we draft these regulations.”

“We welcome the opportunity to hear from health providers and all others interested in this new effort to manage health costs,” said Insurance Commissioner Joseph G. Murphy.  “The Division expects these public sessions will allow each group to hear the others’ concerns and develop a shared perspective and resolve.” 

“Innovating the way we deliver and pay for health care in Massachusetts is a primary objective of Chapter 224 and a top priority for the Health Policy Commission,” said Dr. Carole Allen, chair of the HPC’s Care Delivery & Payment System Reform Committee. “These sessions will allow us to hear directly from the provider community and consumers as we put together guidelines that will strengthen transparency around the organizations charged with delivering lower cost, higher quality care.”

“The HPC is working  with our partners across state government to build a strong foundation for the Commonwealth’s landmark cost containment law, and these sessions are another step in that process,” said HPC Executive Director David Seltz. “We welcome input from all the stakeholders who are pulling in the same direction to make Chapter 224 a success.”

The joint sessions will occur on the following dates and times at the Division of Insurance at Room 1-E at 1000 Washington Street, Boston

  • Friday, March 15 from 9am-12pm
  • Monday, March 25 from 1-4pm
  • Monday, April 1 from 1-4pm

Certification of Risk-Bearing Provider Organizations

DOI is required to annually certify provider organizations that take on certain financial risk through alternative or global payment contracts with insurers. The purpose of certification is to ensure that provider organizations that enter into these kinds of contracts, known as “Risk-Bearing Provider Organizations,” can demonstrate their ability to assume financial risk without threatening their future solvency.  The DOI will issue final regulations before the end of the year to define the process that Risk-Bearing Provider Organizations must follow to obtain for Risk Certificates or Risk Certificate Waivers.

Registration of Provider Organizations

The HPC is responsible for developing and administering a registration program for provider organizations. This program will enhance delivery system transparency, a key goal of Chapter 224. The HPC is seeking suggestions from interested parties about what parameters it should consider as it develops the registration program.

The HPC is the new independent state agency that monitors health care delivery and payment systems reforms and develops policies to reduce overall cost growth while improving the quality of patient care. To learn more, please visit www.mass.gov/hpc or follow the HPC on Twitter @Mass_HPC.

The Division of Insurance is a regulatory agency within the Office of Consumer Affairs and Business Regulation. Find the Division of Insurance online at www.mass.gov/doi, or on Twitter @MassDOI. The Office of Consumer Affairs can be found online at www.mass.gov/consumer or on Twitter @Mass_Consumer.

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