Several medical home projects are underway in Rhode Island.
Chronic Care Sustainability Initiative (CSI-RI)
The multi-payer CSI-RI was first convened by the Rhode Island Office of the Health Insurance Commissioner in June 2006, and corresponded with a state directive for health plans to invest an additional $100 million in primary care. Payment to participating practices began in October 2008 with five pilot sites. Five payers, including Medicaid fee-for-service, Medicaid managed care organizations, and commercial plans have supported the original pilot sites as well as eight expansion sites that joined the project in April 2010. Medicare announced in 2011 that it would begin making payments on behalf of Medicare fee-for-service beneficiaries. The project now has the participation of nearly 100% of Rhode Island payers and purchasers.
Further information is available on the CSI-RI homepage.
Connect Care Choice (CCC)
Rhode Island Medicaid implemented the CCC program in September 2007. This program builds on a primary care case management (PCCM) structure to provide access to advanced medical homes for adults with chronic conditions. Practices with receive per member per month (PMPM) payments to coordinate care for members. The program operates under the authority of Rhode Island’s Global 1115 waiver.
Further information is available on the CCC homepage.
CEDARR Family Centers
CEDARR Family Centers exist to serve children with special health care needs and their families. (CEDARR stands for Comprehensive Evaluation Diagnosis Assessment Referral Re-evaluation.) Children with Medicaid or CHIP coverage are eligible for services. The CEDARR program began in 2000, and features teams led by licensed clinicians (including nurses, social workers, and psychologists). In partnership with primary care providers, the CEDARR staffs perform needs assessments, link to community resources, and develop treatment plans.
Further information is available on the CEDARR Family Center homepage.
Federal support: Many of Rhode Island’s medical home projects are receiving support through various federal funding streams.
- Medicare is joining as a participating payer in CSI-RI through the Medicare Advanced Primary Care Practice (MAPCP) Initiative.
- Rhode Island is a Beacon Community. Beacon Community funding is being used to increase the effective use of health information technology (IT) in medical homes to improve diabetes care, reduce tobacco use, increase screening for depression, and reduce preventable acute care utilization.
- Rhode Island Medicaid has submitted a Health Homes State Plan Amendment to receive enhanced federal funding for the state’s CEDARR Family Center program.
- The federal government provides federal financial participation (FFP) for the enhanced reimbursements that Medicaid/CHIP pay to participating providers under all of the projects.
Last Updated: October 2011
| Forming Partnerships | The Chronic Care Sustainability Initiative (CSI-RI) coalition has been convened by the Rhode Island Office of the Health Insurance Commissioner. In addition to the participating payers and purchasers, partnering stakeholders include primary care provider organizations, the Rhode Island Department of Human Services, and the Rhode Island Department of Health. |
| Defining & Recognizing a Medical Home |
Definition:
The Chronic Care Sustainability Initiative (CSI-RI) has adopted the Joint Principles of the Patient Centered Medical Home as the project’s medical home definition.
Recognition:
CSI-RI uses an approach grounded in the National Committee for Quality Assurance (NCQA) standards. The longest-participating practices (the original pilot sites) are expected to achieve NCQA recognition and establish compacts with four high volume specialists (including at least one hospitalist). The expansion sites are only expected to achieve NCQA recognition.
The Connect Care Choice (CCC) program requires participating primary care providers to meet state-developed standards that include incorporation of the Chronic Care Model, use of team-based care, adoption of e-prescribing, and links to community supports and behavioral health providers. Additional information may be found on page 11 of this report.
CEDARR (Comprehensive Evaluation Diagnosis Assessment Referral Re-evaluation) Family Centers are expected to meet state-developed certification standards that are available online. Additional standards specific to serving as a 2703 health home, such as using health information technology (IT) and conducting regular body mass index (BMI) screenings, have also been developed. |
| Aligning Reimbursement & Purchasing |
Chronic Care Sustainability Initiative (CSI-RI): Under CSI-RI, nearly 100% of payers in Rhode Island are using a common approach to reimburse participating medical homes for providing enhanced services. Prior to Medicare’s participation, the payers shared in the expenses of providing practice-based nurse care managers. They also paid flat $3.00 per member per month (PMPM) fees to participating practices for each attributed patient.
Under the new payment methodology, the participating payers will pay the five pilot practices $5.50 PMPM in the first year, and either $5.00, $5.50, or $6.00 in years two and three depending on practice performance on key quality and cost metrics. The eight expansion practices will receive $3.00 PMPM plus $1.16 PMPM if the practices hire a nurse care manager. If the practices choose to contract with a local hospital to provide nurse care management services, the hospital will receive the $1.16 PMPM stream.
Connect Care Choice (CCC): Practices receive monthly care coordination fees intended to account for the time needed to care for complex patients. Practices that care for moderate to high-risk CCC members and have a nurse care manager integrated into their practice receive PMPM payments of $35-40 PMPM.
CEDARR Family Centers: CEDARR (Comprehensive Evaluation Diagnosis Assessment Referral Re-evaluation) Family Centers receive three distinct bundled rates for services that they perform: initial family intake and needs assessments ($366), family care plan development ($347), and family care plan reviews ($397). Additionally, primary care providers are eligible for enhanced reimbursement for collaborating on care planning with the CEDARR Family Centers. |
| Supporting Practices | Chronic Care Sustainability Initiative (CSI-RI) practices receive support through practice coaching and learning collaboratives. They are also receiving health IT support through the Beacon Community program (see above) as well as ongoing data feedback. Additionally, practices have received support for hiring nurse care managers or contracting for remote nurse care manager support. |
| Measuring Results | The Commonwealth Fund is paying for researchers at the Harvard School of Public Health to conduct an evaluation of the Chronic Care Sustainability Initiative (CSI-RI). The Centers for Medicare & Medicaid Services (CMS) is also evaluating the impact of the CSI-RI on outcomes for Medicare patients through a contract with RTI International. NASHP and the Urban Institute are subcontractors to RTI. Final evaluation results are not yet available, but the state has seen promising improvements in process measures. |
