Health insurance premiums will edge up five to 12.1 percent, depending on the plan, starting the first of the New Year, but the increase could have been greater had it not been for her staff “that looked at every line and challenged every assumption,” says State Health Commissioner Marie L. Ganim.

Of the $128,448,598 in premium increases requested by the state’s five insurers, the commission trimmed $16.7 million, according to a release issued Aug. 17.

In an interview Tuesday Ganim, who was named commissioner in early June, said “there was no fluff” in the rates that will affect more than 220,000 Rhode Islanders. Requested increases in premiums were largely made to cover projected increases in the medical expenses of insured members (particularly prescription drug costs and use of outpatient services) and to fund the reinstatement of the federal health insurance tax.

With the state’s aging population, Ganim doesn’t hold out hope for a reduction in rates going forward. However, she is optimistic about containing costs through a healthier population and taking precautionary steps rather than solely reacting to medical problems.

In response to email questions, Cory King, OHIC principal policy associate said, “Rhode Island is unique among states in that we have an office dedicated solely to health insurance regulation with significant statutory authority to direct insurers toward polices that improve the health care system as a whole.”

King points out two measures taken by the OHIC, and touched on by Ganim, to get costs under control. They are requiring insurers invest in primary care, designed to reduce unnecessary utilization of services and enforcing a cap on the growth of hospital prices through commercial insurer hospital contracts.

“Primary care investments, particularly in the patient-centered medical home model, have led to reductions in inpatient admissions and have improved the quality of care. In addition to these initiatives, OHIC is requiring that insurers increase the percentage of their reimbursements that change the focus from paying for numbers of visits, to paying for quality patient care, through payment models that incentivize providers to manage the total cost of care for their attributed population while meeting quality targets. The most challenging area that we face is the rising cost of pharmaceuticals,” writes King.

Ganim is especially sensitive to the cost of pharmaceuticals and ensuring that price does not deny access to individuals dependent on medication. She is also keen on the patient-centered medical home (PCMH). She explained the “home” as centered on a primary care physician who, with a group of other professionals such as nutritionists and dietitians, can tailor a plan to maintain good health and avert most costly intervention.

King points out the OHIC allows participants, especially the health plans, to avoid any anti-trust issues. The PCMH model, particularly elements related to care management for high-risk patients, has shown improvements in inpatient admissions, he said. King said OHIC has long been a champion for primary care.

“We view a strong primary care infrastructure as necessary to improving quality and affordability,” he said.

He notes that, between 2010 and 2014, OHIC required insurers to increase the percentage of the commercial medical spending dedicated to primary care by 1 percentage point per year, without passing the increase to consumers in the form of higher premiums, increasing resources available to primary care by millions of dollars.

Might greater competition with more insurers reduce costs?

Ganim observes Rhode Islanders already have a selection of choices with Blue Cross & Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, United Health Care and Tufts Health Plan. Both Tufts and United offer HMO and PPO plans.

A total of 43,556 in the individual market, 58,177 in the small group market and 115,372 in the large group market will be impacted by the change in rates that vary by provider and market.

Ganim points out that Rhode Island is among states with the lowest uninsured rates. The estimate is that 5 percent of Rhode Islanders don’t have health insurance.

Prior to her appointment by Gov. Gina Raimondo, Ganim served as the Deputy Chief of Staff and Policy Director for the Rhode Island State Senate. She previously served as the Senate's Director of Health and Human Services Policy.

Ganim holds an undergraduate degree in political science from Providence College, a master's degree in public administration from Syracuse University and a Ph.D. in public and international affairs with a specialty in health policy from Northeastern University.