Welcome to our new board members!

CTC-RI is pleased to introduce the newest members of our Board of Directors. Our new leaders bring a wide range of expertise and experience to our organization, representing skill and knowledge in pediatrics, pharmacy, behavioral health, LGBTQ+, healthy aging, community health, and more. Join us in welcoming these talented leaders to our organization as we continue to grow and transform primary care for Rhode Islanders statewide.

We'd also like to give a special thanks to our departing institutional board member, Matthew Collins, MD, MBA, who served as Executive Vice President/Chief Medical Officer at Blue Cross & Blue Shield of RI. Dr. Collins' leadership and guidance has inspired us to provide more effective care for our patients and families. Thank you for the positive impact you have had on CTC-RI and on Rhode Island's primary care community.

"Blue Cross & Blue Shield’s vision is to improve health and well-being by leading access to high-quality, affordable, and equitable care. The partnership between BCBSRI and CTC-RI helps us to achieve this vision. Supporting CTC-RI through my involvement with the Board of Directors and other committees has been among the most rewarding and gratifying experiences." - Dr. Matt Collins

Call for applications: 2023 Asthma Quality Improvement Initiative

In collaboration with the RI Dept. of Health and Tufts Health Plan, CTC-RI is offering the opportunity for up to 6 primary care practices to apply for funding to participate in a 6-month Asthma Quality Improvement Initiative.

CTC-RI will provide funding to support health care practices (pediatric, family medicine and adult medicine) in their efforts to participate in this data-driven initiative to improve the management of patients diagnosed with asthma.

The need for an Asthma Quality Improvement Initiative has grown out of the RIDOH Asthma Strategic Plan and RI data that shows striking racial/ethnic and socioeconomic disparities in pediatric asthma outcomes. Further, even though asthma is controllable, an estimated 50% of children have uncontrolled asthma and 40% of adults reported having one or more asthma attacks in the last year.

View the full call for applications and details. Applications are due February 24. Project activities will begin April 12 and continue for 6 months.

Telehealth updates with final RI Telehealth Project report

CTC-RI is pleased to share the final “Rhode Island Telehealth Project Report.” This 3-phase telehealth project, funded by UnitedHealthcare and Cares Act Funding ran from summer 2020 through spring of 2022. Please see the report for overall findings and results, including details on the needs assessment, webinar series, learning collaborative, telehealth planning committee, and participating practices. 



In other telehealth news, Health and Human Services announced the 90-day extension of the full Public Health Emergency (PHE) Flexibilities. Together with the "2023 Updates to Physician Medicare Fee Schedules and Telehealth" and the extension of the PHE, most telehealth flexibilities will be available throughout 2023. 

From CMS: “For CY 2023, we are finalizing a number of policies related to Medicare telehealth services, including making several services that are temporarily available as telehealth services for the PHE available at least through CY 2023 in order to allow additional time for the collection of data that may support their inclusion as permanent additions to the Medicare Telehealth Services List.”

Please click on the following links sharing resources with more information:

• Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19
• CY 2023 Medicare Physician Fee Schedule (PFS)
• CMS Telehealth Codes
• List of Telehealth Services for Calendar Year 2023 (ZIP) - Updated 11/02/2022
• Northeast Telehealth Resource Center
• Center for Connected Health Policy

January Clinical Strategy meeting highlights approaches to dementia care

The January Clinical Strategy Committee meeting focused on approaches to dementia care in RI, moderated by Victoria Parker, MS, Alzheimer's Disease and Related Disorders Program Manager, RIDOH. Tom Bayer, MD, Brown Medicine Division of Geriatrics and Palliative Medicine, highlighted the importance of comprehensive, collaborative care for patients with dementia and ways Brown is connecting patients with dementia to care specialists and social workers through team-based care and leveraging evidence-based practices.

Ana Tuya Fulton, MD, MBA, FACP, AGSF, Chief Population Health Officer, Care New England & Executive Chief of Geriatrics, and Chief Medical Officer, Integra Community Care Network spoke to the patient care model for geriatric patients at Integra. Dr. Fulton also discussed integration with the Kent Hospital at Home program. Victoria Parker spoke about the Quality Improvement Collaborative, which convenes subject matter experts, state agencies, community-based organizations, and health system partners to understand and identify opportunities to support the care and management of patients with dementia in RI. Reactants were Matthew Collins, MD, MBA, Executive Vice President and Chief Medical Officer, BCBSRI; Kelley Hurley, BS, PTA-ADPI, Grant Program Coordinator, CareLink; and Robyn Early, MA, Chief Growth Officer, CareLink. Participants also learned about services through CareLink and their mission to provide post-acute and community-based services for RI older adults.



To view the recording, find additional resources and claim CME credit, check out our page on CME Coursework.

Asthma Essentials ECHO on patient and family education

Our 5th Asthma Essentials ECHO brought together 36 participants and was facilitated by Pat Flanagan, MD. The didactic session, presented by June Tourangeau, Certified Asthma Educator, focused on “Patient and Family Education Considering Lower Income/Vulnerable Population” and provided participants with resources to help them with promoting asthma self-management education. Misotis Alsina, Program Manager of the Community Asthma Programs and Administrative Director of the Asthma Camp at Hasbro Children’s Hospital, provided the case presentation which allowed for richer discussion of caregiver supports, patient medication, and symptom identification.



Also, CTC-RI in collaboration with RI Department of Health (RIDOH) and Tufts Health Plan announced the call for applications for a 6-month Asthma Quality Improvement Initiative. Funding will be available for up to 6 primary care practices working within systems of care. To learn more and apply, please see the full call for applications.



Asthma Essentials ECHO is funded in part by RI Department of Health and Tufts Health Plan. Access materials and the recording from previous meetings here. 

Quarterly Integrated Behavioral Health Committee meeting

CTC-RI hosted the Quarterly Integrated Behavioral Health (IBH) Committee Meeting in February, bringing together over 30 RI professionals in the field for a great discussion. Attendees from several practices across the state joined the conversation, as well as members of community based service organizations, and insurance providers. A portion of the meeting was dedicated to discussing the barriers clinicians face joining the IBH workforce, as well as incentives and opportunities for clinicians to enter into IBH programs. 6 new projects being launched by CTC-RI were announced, including projects with a pediatric focus, IBH training series, and incentive programs for clinicians.

Several calls for applications will occur in 2023, and a full list of new IBH projects are below:

• IBH Clinician Training – Workforce Development
• Expanding IBH Capacity in Pediatrics
• Reimagining High-Functioning, Team-Based Primary Care
• Developmental Understanding and Legal Collaboration for Everyone (DULCE)
• Restrictive Eating Disorders in Children
• Incentivizing Community BH Providers to enter into IBH arrangements

Thank you to Blue Cross & Blue Shield of RI, UnitedHealthcare and RI Department of Health for this funding support.

This meeting also announced new OHIC Affordability Standards, which you can access via the link here. To view the Quarterly IBH Meeting recording, please use the link here.

Workshop focuses on intersection of depression and anxiety with common medical conditions

As part of a collaboration between Prospect Health Services RI's Accountable Entity and CTC-RI, Dr. Nelly Burdette, Senior Integrated Behavioral Health Program Leader, presented a workshop in January to the clinical nurse care managers and behavioral health team on how depression and anxiety intersect with common medical conditions.

Garry Bliss, Program Director-Medicaid AE, stated, "We are seeking to embed the integrated behavioral health approach across the board – from primary care to complex care management – so that the patients we work with realize the benefits of this holistic approach to health. This training session is just one example of the ways that CTC-RI is helping us build our capacity for addressing the dynamic interaction between physical and mental health." Jill Taormina, Director of Care Management stated, "Dr. Burdette’s January in-person IBH session on depression and anxiety and comorbid medical issues was truly appreciated by all in attendance. She fostered an environment where everyone felt comfortable sharing case studies and participating in dynamic group discussion, allowing our team to fully learn the skills needed to bridge the clinical and behavioral aspects of care management resulting in more successful patient engagement, increased confidence, and greater job satisfaction."

This workshop was a part of a series of trainings by Dr. Nelly Burdette, with an upcoming March session focused on Substance Use Disorder.

February update: Medicaid Pediatric Healthcare Recovery Program

Medicaid Pediatric Healthcare Recovery Program – Year 2 Update: 75% of practices enrolled in the Medicaid Pediatric Healthcare Recovery Program met 3 out of 4 January immunization / lead screening targets or improvement targets. Practices that achieved this milestone should have received their payment by February 13. Practices can expect to receive ongoing KIDSNET performance reports around the 18th of the month which will provide a status of the practice’s achievement in meeting 3 out of 4 immunization / lead screening targets or improvement targets for the next milestone in April. In addition, practices have available to them through KIDSNET, a new immunization report that will assist practices in identifying children that are due for immunizations. Instructions on the use of this report can be found here. Your Practice Facilitators are here to help. A special thank you to KIDSNET and RIDOH Lead Program staff for their heroic efforts in ensuring that immunization and lead screenings were properly reflected for the Medicaid Pediatric Healthcare Recovery Program January performance report.

80% of practices attended the 1st Behavioral Health ECHO® on Difficult Conversations which focused on vaccine hesitancy. Practices are eligible for participation payment based on practice staff attending 4 out of 6 Behavioral Health ECHO® Learning Sessions with practice payment due in July 2023. Completion of an evaluation for each session attended is required to receive credit for attendance. Please register for the February 22 Behavioral Health ECHO learning session with topics and dates listed here.

Read: The Unique Value Proposition of Pediatric Health Care

PCMH Kids co-director Dr. Pat Flanagan and the American Academy of Pediatrics Committee on Child Health Financing has released a document providing a framework for the value proposition of pediatric health care. It is intended to provide a succinct set of principles for establishing this proposition that demonstrates the short and long-term value to the child and family, the health care system, and society as a whole. Read more here.