Rhode Island

Rhode Island has a long history and continued commitment to using the PCMH as the foundation for all health care improvement efforts in the State. In 1999, the Rhode Island Chronic Care Collaborative grew out of a partnering of the Rhode Island Department of Health Diabetes Prevention & Control Program and the Thundermist Health Center in the Bureau of Primary Health Care Health Disparities Collaborative for diabetes. Between 2000 and 2002 the Diabetes Prevention and Control Program created an in state collaborative with the addition of ten community health centers and one hospital-based practice. In 2003 the Diabetes Prevention and Control Program and Quality Partners of Rhode Island (now Healthcentric Advisors) received a grant from the Robert Wood Johnson Foundation’s Improving Chronic Illness Care program to train physician practice teams based on the Bureau’s Collaborative model. 

Launched in 2008 by the Office of the Health Insurance Commissioner, the R.I. Chronic Care Sustainability Initiative (CSI-RI) brings together key health care stakeholders to promote care for patients with chronic illnesses through the patient-centered medical home (PCMH) model. CSI-RI began with five pilot sites in 2008, added eight sites in 2010 and another three sites in October 2012. Currently, over 85,000 Rhode Islanders receive their care from CSI-RI practices. Over the next five years, 20 practices will be added each year, with the goal of providing over 500,000 Rhode Islanders with access to a PCMH. 

In July of 2011, Rhode Island passed 2011 S 770 – Rhode Island All-Payer Patient Centered Medical Home Act of 2011, which directed the Health Insurance Commissioner to create a Patient-Centered Medical Home Collaborative. The Collaborative conisted of various stakeholders including providers, insurers, patients, hospitals, and state agencies, and was required to develop a payment system that mandated all insurers to provide care coordination payments to PCMHs by July of 2012. The Act requires that the care coordination system be in place through at least July of 2016.  

Rhode Island’s State Health Care Innovation Plan builds on the success of all these programs and include ongoing training and payment support for primary care practices transforming to PCMHs, integration of behavioral health in primary care, increased use of ACO's or ACO-like structures to align payment with quality, expanding the use of community health teams for high-risk populations, and continued development of analytic tools that can be leveraged by the State, providers, and payers.

For more detailed information about public programs in Rhode Island, visit the National Academy of State Health Policy.

CHIPRA: 
No
MAPCP: 
Yes
Dual Eligible: 
Yes
2703 Health Home: 
Yes
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
1,048,300
Uninsured Population:
9%
Total Medicaid Spending FY 2013: 
$1.9 Billion 
Overweight/Obese Adults:
64.6%
Poor Mental Health among Adults: 
35.3%
Medicaid Expansion: 
Yes 
CPC+: 
CPC+

Pharmacy integration helped BCBS of Rhode Island lower costs, improve care

on Mon, 2015-08-10 00:00   marcos

Although pharmaceutical costs are a key driver of healthcare costs, it's frequently assumed that's because of the high price of drugs, specialized treatments for complex diseases and unnecessary prescriptions. Yet studies have shown that medication non-adherence adds up to $290 billion per year to healthcare costs in the U.S.

Story Date: 
August 10, 2015
News Author: 
Beth Herbert
Source Link: 
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Rhode Island Integrated Care Initiative

In July 2015, CMS signed a Memorandum of Understanding with the state of Rhode Island to pilot the Medicare-Medicaid Alignment Integrated Care Initiative Demonstration. The goal of Rhode Island’s Integrated Care Initiative (ICI) is to improve the care and quality of life for elders and adults with disabilities who are eligible for both Medicare and Medicaid.

CMS and Rhode Island Partner to Coordinate Care for Medicare-Medicaid Enrollees

on Thu, 2015-07-30 00:00   lisabeth

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new partnership with the State of Rhode Island to test an initiative to improve services for Medicare-Medicaid enrollees.  The new demonstration will allow Rhode Island and CMS to contract with a Medicare-Medicaid Plan to provide an integrated set of Medicare and Medicaid benefits for enrolled beneficiaries. Approximately 30,000 Medicare-Medicaid enrollees in Rhode Island will be eligible for the demonstration.

Story Date: 
July 30, 2015
Source Link: 
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R.I. health-care leaders celebrate improvements, cost savings statewide

on Thu, 2015-05-21 00:00   lisabeth

Health-care leaders gathered on Thursday to celebrate strides that Rhode Island has made in improving primary care, namely the spread of doctor's offices called "patient-centered medical homes" — soon to be expanded to pediatric practices. 

But they said that Rhode Island still has a long way to go to make health care more affordable and to better coordinate care between primary physicians, behavioral experts, specialists and hospitals. 

Story Date: 
May 21, 2015
News Author: 
Richard Salit

Source Link: 
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UnitedHealthcare Patient-Centered Medical Home Program- Rhode Island

UnitedHealthcare currently operates 13 medical home programs in 10 states for the commercially insured population  These programs include more than 2,000 participating physicians and 300,000 members. 

2011 S 770 – Rhode Island All-Payer Patient Centered Medical Home Act of 2011

The Act directed the Health Insurance Commissioner to create a Patient-Centered Medical Home Collaborative. The Collaborative conisted of various stakeholders including providers, insurers, patients, hospitals, and state agencies, and was required to develop a payment system that mandated all insurers to provide care coordination payments to PCMHs by July of 2012. The Act requires that the care coordination system be in place through at least July of 2016.

Public, Private Help Smooth Transition to Medical Home

on Wed, 2015-01-21 00:00   caroline

For some primary care physicians, the idea of transforming a practice into a medical home sounds like a major risk.

Yet practices that have made the change in states such as Rhode Island have reported smooth transitions, thanks in part to financial and technical support from public and private entities. By hiring a care manager and training existing staff to take on additional care tasks, the model can succeed, these physicians say.

Story Date: 
January 21, 2015
News Author: 
Michael Laff
Source Link: 
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UnitedHealthcare - Rhode Island Primary Care Physicians Corporation (RIPCPC) ACO

In December of 2014, Rhode Island Primary Care Physicians Corporation (RIPCPC) and UnitedHealthcare launched an accountable care organization (ACO) to improve care coordination and provide enhanced health services for more than 15,000 Rhode Island residents enrolled in UnitedHealthcare’s employer-sponsored health plans. 

Improving Integrated Behavioral Health in Rhode Island

on Thu, 2015-01-08 00:00   lisabeth
Tufts Health Plan Funds Three Initiatives With a Focus on Patient-Centered Medical Homes within Primary Care Practices

With a commitment to integrated behavioral health and the importance of the patient-centered medical home model for primary care in Rhode Island, Tufts Health Plan has funded three projects in the state. The projects, which will be implemented in 2015, are designed to test strategies for increasing patient access to behavioral health services within primary care settings.

Story Date: 
January 8, 2015
Source Link: 
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Rhode Island Primary Care and UnitedHealthcare Collaborate to Improve Patient Care in Rhode Island

on Thu, 2014-12-18 00:00   lisabeth

Rhode Island Primary Care Physicians Corporation (RIPCPC) and UnitedHealthcare have launched an accountable care organization (ACO) to improve the care coordination and provide enhanced health services for more than 15,000 Rhode Island residents enrolled in UnitedHealthcare’s employer-sponsored health plans.

Story Date: 
December 18, 2014
Source Link: 
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