PROVIDENCE, RI – Blue Cross & Blue Shield of Rhode Island (BCBSRI) is strengthening its longstanding commitment to ensure timely and convenient access to high quality primary care in Rhode Island through important payment and administrative simplification efforts. 

Working cooperatively with Gov. Dan McKee and the Health Insurance Commissioner’s Office, and complementing legislative efforts led by R.I. Senate President Dominick Ruggerio and House Speaker K. Joseph Shekarchi to bolster the state’s healthcare system, BCBSRI is increasing payments to primary care providers (PCPs) in Rhode Island by a total of approximately $40 million dollars through 2028. 

In addition, BCBSRI is reducing PCP medical prior authorization requirements starting next month, as well as offering a new contract option that provides PCPs with advance monthly payments.  These new contracts will improve financial stability and predictability for primary care practices to support their efforts to hire staff and expand patient access. 

Alongside efforts to ensure greater PCP satisfaction and stability, BCBSRI is aiding members whose access to primary care is in jeopardy due to the unexpected closure of Anchor Medical Associates. BCBSRI has been coordinating with PCPs in the network that have the capacity to accept new patients and contacting impacted members with options for PCP placement assistance. 

“Primary care is critical to the health of Rhode Islanders of all ages. With its focus on disease prevention, management of chronic conditions, and care coordination, primary care is foundational to our state’s healthcare system,” said Martha L. Wofford, president and CEO of BCBSRI. “We recognize that it is a challenging time for healthcare and, we’re hopeful that these efforts will help increase stability for PCPs and preserve Rhode Islanders’ access to care.” 

BCBSRI’s four-year, $40 million increase in payments for primary care will begin this summer. On July 1, BCBSRI will raise commercial fully insured reimbursement rates for PCPs by 15%. Additional annual rate increases will follow through 2028.  

The series of increases align with the Office of the Health Insurance Commissioner (OHIC’s) new affordability standards. Finalized earlier this year, they call on insurers to increase funding for primary care and reduce PCP administrative burden from prior authorization requirements. 

Beginning May 15, BCBSRI will eliminate 65% of medical prior authorization requirements for primary care physicians for both commercial and Medicare plans. Prior authorization helps ensure that patients are receiving appropriate, safe, and cost-effective care and reduces clinical variation in care.  Recognizing that prior authorization can create administrative burden for physicians and delays for patients, BCBSRI took a data-driven approach to identify some of the most common orders that create additional work for PCPs, with radiology and cardiology leading the list.