September 2015   
Care Transformation Collaborative of Rhode Island
Save the Date for the CTC Learning Collaborative
The CTC Learning Collaborative "Primary  Care Plus: Paving the Way" will be held on November 12, 2015 from 7:30am to 12:30pm at the Renaissance Hotel, Providence RI. 

The Learning Collaborative will feature national and regional speakers  as well as local experts who will focus on key topic areas to assist primary care practices with functioning  successfully in the patient centered medical home and ACO environments. 
RIQI's Educational offerings for October
Webinar: HOT HIPAA Topics: HIPAA Compliance Update with Linn Freedman
Friday, October 2, 2015 7:30 - 9:00 am

Webinar: Security Risk Assessments - What You Need to Know
Thursday, October 22, 2015 12:15-1:00 PM 

Free Webinar: CurrentCare Quick Bites
Webinar: Hop on the Train! - Get Your Patients to Enroll
Wednesday, October 7, 2015 - 12:15 - 12:30 pm 
Lifespan Healthy Rewards Program 
The Lifespan Healthy Rewards  program for 2015 is coming to a close on Saturday, October 31.  Learn more about how practice staff can assist patients by participating in Lifespan Healthy Rewards, earn up to $300 in incentives, and how  practices  can receive fees for completing patients' forms as well as a follow-up visit fee: Lifespan Healthy Rewards benefits Lifespan employees and their providers!

CTC in the News 

PBN: "Five Questions With: Dr. Christopher Klaus" - 8/31/2015

Practice Resources
" Guide for Caregivers" - Rhode Island Executive Office of Health and Human Service 
Upcoming Meetings:
October 1, 2015 8:00-10:00AM Joint Advisory Committee (Department of Labor and Training) 

October 6, 2015 7:30-9:00AM
Data and Evaluation Committee (Memorial Hospital) 

October 9, 2015 7:30-9:00AM
CTC Steering Committee (RIQI) 

October 9, 2015 9:30-10:30AM 
Community Health Team Planning Committee (RIQI) 

October 13, 2015 8:00-9:00AM 
CTC Nurse Care Manager Best Practice Sharing (RIQI) 

October 14, 2015 7:30-9:30AM
Open Notes (RIQI) 

October 15, 2015 7:30-9:00AM 
CTC Practice Transformation (RIQI) 

October 15, 2015 3:00-4:30PM
CTC-RI Integrated Behavioral Health (RIQI) 

October 16, 2015 7:30-9:30AM
CTC Clinical Strategy and Cost Committee (Thundermist, Warwick) 

October 19, 2015 7:00-8:30AM 
South County Steering Committee (South County Hospital) 

October 23, 2015 7:30-9:00AM 
CTC Board of Directors Meeting 
(Healthcentric Advisors) 

October 23, 2015 9:30-10:30AM
Community Health Team Planning Committee (Healthcentric Advisors) 

October 26, 2015 9:00-10:30AM
CTC Program Evaluation Committee (RIQI) 

October 27, 2015 7:30-9:00AM
Contracting Committee (RIQI) 

October 27, 2015 8:00-9:30AM
Practice Reporting (RIQI) 

October 29, 2015 8:00AM-12:00PM
Lean Training (RIQI) 

For meeting details or to receive a calendar invite please contact:
Nicole Mossey
CTC of Rhode Island

235 Promenade Street

Suite 500, Box 18

Providence, RI 02908

Welcome to the Care Transformation Collaborative of Rhode Island Newsletter, where CTC shares exciting updates, news, milestones, meeting information and more.
CTC "Raises the Bar" for 2015-16 Performance Targets
Each year, CTC Data and Evaluation Committee, with input from Practice Reporting Committee, reviews the previous year's  practice performance data based on the previous year's performance. CTC has seen that practices have consistently demonstrated  directional improvement on quality and customer experience metrics. Accordingly, the  Data and Evaluation Committee has established new targets for both quality and customer experience  measures for the 2015-2016 contract year.
Building Skills in Primary Care: Assisting Patients with Chronic Pain
Results from an integrated behavioral health (IBH) needs assessment survey showed that primary care practices rated assisting patients who have chronic pain as the number one learning need. As part of CTC's IBH initative , Nelly Burdette,  Psy.D presented "Skills Not Pills,"a webinar which provided information on assessing patients with  chronic pain and provided practice resources that patient and clinicians could use to assist with  managing the pain experience. 

The "Skills not Pills" presentation includes links to  patient self management tools (setting personal goals, improving sleep, increasing physical activity and  managing stress) that can be found at the end of the power point presentation. Special thanks are extended  to Tufts Health Plan for providing financial support for the IBH workforce development program.
The Rhode Island Office of the Health Insurance Commissioner (OHIC) Seeks Input on Proposed RI PCMH Strategies 
Commissioner Kathleen Hittner, MD invited primary care practices to provide input on the proposed RI Patient Centered Medical Home Cost Containment Strategies . The proposed standards are  intended to improve care coordination, provide increased access to care and align health care payment  methods with efficiency and quality. CTC gathered comments through various CTC committees and  provided feedback to Dr. Hittner on the PCMH initiative, which represents a continued in vestment in primary care.

Read the letter and summary of feedback from CTC to Dr. Hittner here
NCQA Corner: Improving Care Coordination
The 2014 NCQA Patient Centered Medical Home Standards, asked practices  to measure or receive quantitative data on at least two measures related to care  coordination. 

Care coordination measures "assess the deliberate organization of patient care activities  between two or more participants (including the patient) involved in a patient's care to facilitate the  appropriate delivery of health care services" (AHRQ).

The CTC Nurse Care Manager measurement f ramework establishes a systematic approach that practices can use to measure and improve care  coordination with high risk patients. 

Starting with the October 2015 quality measurement period, practices in Transition through Advanced Collaborative status, will start measuring nurse care manager activity with high risk patients. Practices  are asked to collect data on different categories of high risk patients  and nurse care manager  care coordination activities. Practices will be able to use this data to measure and improve performance  in transitions of care (Category 1aED and Category IP) and care of patients with multiple chronic  conditions (Category 2).
Workforce Development Opportunity: COPD "Train the Trainer" Program
The New England QIN-QIO is pleased to announce that the Greater Providence Coalition, in an effort to  impact care transitions and reduce unnecessary hospital readmissions, has developed a COPD  Zones/Action Plan Tool and is aiming for standardized education across care settings to promote
consistent messaging to patients. A "Train the Trainer" program is being offered for those providers that  care for patients in the Providence and Greater Providence community, that wish to be involved in this  important initiative. The 3 hour session (CEU application submitted), will be offered on two separate  dates to accommodate staff trainers: 

October 27, 2015 7:30-11:00am, at Healthcentric Advisors. 

October 28, 2014 4:30-8:00pm, at Healthcentric Advisors. 

This first phase is being rolled out in the Providence/Greater Providence  community. Minimal data collection is required for participating providers; this will inform the PDSA  cycle prior to spreading the initiative to other communities. Trainers will utilize educational materials f ound in the "Lung Talk: Living with COPD" resource guide
Opportunity to Prepare for the Asthma Education Certification Board Exam
The RI Department of Health's Asthma Control Program recently announced sponsoring another 2015  Asthma Educator Institute, which will be held on October 22nd and 23rd in Conference Room A at the RI  Department of Administration.  

This two day prep course is designed to prepare health professionals for the rigorous National Asthma Educator Certification Board exam to become a Certified Asthma Educator (AE-C).  The course is offered  in a joint partnership between the RI Department of Health, the RI Association of Certified Asthma  Educators, and the American Lung Association Northeast.

Registration and payment is available online The course is $150 per participant, with limited scholarships (50% discount) available for eligible bilingual individuals . CTC practices may also apply for funding to attend  program and take exam through the "Partnering in Best Practice" program.

Application has been made for CEUs to be available for nurses and respiratory therapists, the r egistration deadline for this event is October 9th.
The Impact of CurrentCare Hospital Alerts
Helping to manage care and reduce 30-day ED return rates
CurrentCare's Hospital Alerts service is helping to reduce hospital  readmissions and coordinate care. Analysis by the Rhode Island Quality  Institute (RIQI) which owns and operates CurrentCare, Rhode Island's  statewide Health Information Exchange (HIE), shows that among CurrentCare  enrollees, the 30-day return rate to the ED is approximately 20% lower for  patients whose providers receive Hospital Alerts versus patients whose providers do not. And, the  difference between the two groups has held over time, even as the number of providers receiving alerts  has grown. To read more about these results and learn how you can get started with Alerts, click here.