Sen. Lauria reflects on legislative efforts to support primary care

We connected with Senator Pamela Lauria (District 32), a practicing primary care nurse practitioner at Coastal Medical and member of the CTC-RI Primary Care Workforce Task Force, on important work happening at the State House to bolster the primary care workforce.

Primary care in Rhode Island is facing an unprecedented workforce crisis. In what ways are you collaborating with CTC-RI and primary care leaders to address this?

I have been on the Primary Care Task Force and support the recommendations made in the Task Force's Strategic Roadmap for Primary Care. Additionally, I have been collaborating on legislation to address two of the biggest issues related to training enough primary care providers. First, we have a bill to address the insufficient number of training sites for clinical placements for students in primary care programs. The bill (Senate Bill 2716) will provide funding for the development of a curriculum and preceptor training for 30 clinical sites. It will also provide funding for the clinical sites to provide compensation to the preceptor in either a stipend or reduced productivity. Second, we have a bill to address barriers to being able to afford going into primary care by providing scholarships for students attending medical school, nurse practitioner and physician assistant programs (Senate Bill 2717). The scholarships are intended to cover the full cost of tuition and fees for their program, with a promise to remain in RI and practice in a primary care setting for at least eight years. Primary care does not provide the compensation of many specialties, and this would make the decision to enter this critical space in medicine more economically feasible. 

Through your legislative leadership, what are you working toward or hoping to see during this General Assembly session to help strengthen primary care?

The legislation mentioned above will help address the training and recruitment of primary care providers for Rhode Island’s future. However, we must have more immediate remedies to retain our current primary care workforce who can practice just over our borders in Massachusetts or Connecticut for more money, often 20-30% more. Rhode Island must increase its insurance rates paid for primary care services in order for practices to be able to compensate providers enough to maintain and grow our workforce. I sit on the Health & Human Services Committee in the RI Senate and have advocated for OHIC to include primary care in its rate review process. Additionally, I have had many conversations with Senate leadership about the urgent need to increase Medicaid rates and the need to incentivize private insurers to increase their rates for primary care services.

In your years of experience as a practicing primary care nurse practitioner, what opportunities or successes are emerging to better support the workforce that we should continue to invest in or strengthen? 

Advanced Practice Providers (NPs and PAs) are becoming an increasingly critical component of our primary care workforce. I have seen practices develop true care teams that work to blend physicians and APPs in a professional and collaborative way, rather than a top-down hierarchy. I think this approach needs to be encouraged and supported. I have also seen enhanced training and mentorship for recent graduates of medical school and APP programs to better support clinicians in the early phase of their careers. This needs to continue and grow while also developing supports for clinicians in their mid-career or late-career in order to help prevent burn-out. 

Want to present at our Annual Conference? Apply by April 5!

CTC-RI's 2024 Annual Conference, "Investing in Primary Care and Health Equity" is scheduled for October 31, featuring discussions on various topics including health equity, priorities in population health, best practices in behavioral health, and improving child/family health, among others.

Primary care team members, systems of care, health plans, and community-based organizations are invited to submit abstracts for concurrent sessions by April 5. Our annual conference attracts more than 300 decision makers, health plan leaders, primary care providers, community-based organizations, and health leaders, providing a unique opportunity to explore solutions and innovative practices for improving care across the state. View the full call for applications, requirements, and more details here.

Apply by April 18! Optimizing a Behavioral Health Approach to Children's Sleep in Pediatrics

CTC-RI is excited to announce a funding and training opportunity to increase practice learning on healthy sleep in pediatrics. Funded by Blue Cross & Blue Shield of RI, selected practices will participate in a 12-month ECHO® program that will include didactic training and case-based learning. Practices will choose between two different tracks, with the addition of a quality improvement project for track 1 practices.

ECHO® is an all-teach, all-learn model, including a brief presentation from a subject matter expert followed by a case study to elicit discussion and recommendations. CTC-RI has engaged Dr. Julie Boergers, Co-Director of the Pediatric Sleep Disorders Clinic at Hasbro Children’s Hospital, as our content expert for this series. Apply by April 18. Learn more.

Update: February Pharmacy QI Learning Collaborative meeting

Practices enrolled in our initiative reported out on their Plan-Do-Study-Act QI progress on sustainability. Pharmacists shared how they are engaging other team members and what criteria is used to “graduate” patients from the Pro CGM program. In addition, pharmacists shared patient success stories on how Pro CGM is making a difference in patient care. Stephen Kogut, PhD, MBA, RPh from University of RI, presented aggregate data on the program. Results continue to show an overall drop in patients’ A1c. Special thanks to UnitedHealthcare and RIDOH for funding this important quality improvement initiative. Read more.

Healthy Tomorrows: a cohort wrap-up and new cohort kickoff.

Last month, Cohort 4 practices and family visiting agencies were introduced to the opportunities of the Healthy Tomorrows program through Cohort 3’s final report-out of their successes, challenges, and recommendations. They shared heartwarming patient stories of successful collaborations between primary care practices and family visiting agencies that resulted in positive outcomes for patients and families. Over the next three months, Cohort 4 practices and family visiting agencies will begin building relationships through mutual awareness. Thank you to Tufts Health Plan/Point32Health and RIDOH for funding this important quality improvement initiative. Read more.

Update: DULCE Quarterly Learning Collaborative Meeting

Earlier this month, CTC-RI hosted its quarterly DULCE Learning Collaborative. This meeting focused on sharing progress from the five participating practices on enrollment of new families, sustainability planning, and what it means to take a universal approach to enrolling families. Practices shared case studies on their success of the interdisciplinary teams in supporting families, such as housing barriers, DCYF involvement, and enrollment in state benefits and how the interdisciplinary teams helped families address these barriers. Funding is provided by Congressional Direct Spend, UnitedHealthcare, RIDOH, and Tufts Health Plan/Point32Health. Read more.

Recap: February and March Clinical Strategy Committee

CTC-RI hosted our February Clinical Strategy Committee centered on a new Alcohol Use Disorder proposal and the alignment with Certified Community Behavioral Health Centers in RI The project goal is to share best practices in alcohol treatment, foster communication between community partners and patients, and build resiliency in primary care to better manage patients living with substance use disorder. Presenters also shared data on RI AE Inpatient and Emergency Room trends, Alcohol and SUD impacts in ED and Inpatient Utilization, and partnerships of Certified Community Behavioral Health Clinics and other Designated Collaborating Organizations.

Our March Clinical Strategy Committee focused on our Pharmacy Quality Improvement Initiatives and their impacts on primary care. Presenters highlighted exciting pharmacy projects, including the Safe-Effective-Efficient Use of Medication in Older Adults, Avoidance of ED/Preventable Hospitalization, Professional Continuous Glucose Monitoring, and the Diabetes-related Retinopathy & Nephropathy Screening projects. Read more.

Recap: Next Building Block: Implementing the 4M Age-Friendly Framework for Better Care of Older Adults and People Living with Dementia

Last month, CTC-RI concluded the final learning collaborative for "The Next Building Block: Implementing the 4M Age-Friendly Framework for Better Care of Older Adults and People Living with Dementia." Practices shared valuable insights from their PDSA cycles and compared their pre-/post-baseline data which helped identify how to assess and act on each of the age-friendly concepts in their care for people over 65. Engaging discussions were prompted by insightful questions, focusing on how practices implemented workflows to test and sustain change and their interest in pursuing Level 2 IHI age-friendly recognition. Notably, five practices were well-prepared to submit for Level 1 IHI recognition, with four practices already having achieved this milestone. 

Looking ahead, focus shifts to our upcoming ECHO series, "Supporting People Living with Dementia and their Care Partners - Identifying Community-Clinical Linkages to Deliver Dementia and Age-Friendly Care." Scheduled to commence in April, interested participants must register by April 4. Thank you to UnitedHealthcare, RIGEC, RIDOH, and the participation from our QI practices for assisting with a successful project.

Recap: Team-Based Care Meeting on Deprescribing: Considerations, Implementation, and Best Practices

In March, CTC-RI and RIGEC hosted our Best Practices in Team-Based Care meeting on “Deprescribing: Considerations, Implementation, and Best Practices”, featuring speaker Christine Eisenhower, Pharm.D., BCPS, Clinical Associate Professor of Pharmacy at the University of Rhode Island. During the session, participants learned about evaluating older adult patients through reviewing case studies to determine deprescribing appropriateness with particular attention to timeframes when deprescribing might be most helpful. Opportunities and challenges for deprescribing among interdisciplinary team members were discussed together with resources that could be used to optimize shared decision-making. The meeting showcased a strong attendance with over 80 people attending. The Best Practices in Team-Based Care meetings will continue to be held every third Tuesday of the month from 8:00-9:00am. View recording here.

Final Session: Demographic Data Collection Pilot Train-the-Trainer Series

In March, CTC-RI held its sixth and final session of our successful Train-the-Trainer series for the Demographic Data Collection Pilot focused on participant sharing. Practices discussed what they have learned, shared insights into the utilization of funds from their Technical Enhancement applications, and how they have implemented changes to policies, workflows, and training. The session concluded with an open discussion on themes such as addressing patient and family concerns when soliciting REL and SOGI information in both adult and pediatric practices, as well as fostering collaborative problem-solving and knowledge exchange. Thank you to our funders from EOHHS and all participating practices for their dedication and contributions to this project. Read more.

Upcoming CTC-RI Committee Meetings and Workgroups

• April 03, 02:30-03:30PM – Demographic Data Monthly Committee Meeting
• April 04, 07:30-08:30AM – Improving Child Health in RI (formerly PCMH-Kids Stakeholder Meeting)
• April 10, 08:00-09:00AM – Primary Care Workforce Taskforce Meeting
• April 19, 07:30-09:00AM – Clinical Strategy Committee Meeting
• April 26, 07:30-08:45AM – Board of Directors

Upcoming Learning Collaboratives and Professional Development

• April 03, 07:30-08:30AM – PCP/Specialist Monthly Oversight Meeting
• April 03, 10:30-11:30AM – RIHCA and Workforce Development
• April 08, 11:00-12:00PM – CTC-RI/RIDOH HEZ Community of Practice: Bridging the Clinical Community Divide
• April 16, 08:00-09:00AM – Best Practices in Team-Based Care
• April 18, 07:30-08:30AM – ECHO: Increasing Access to Care for Children and Adolescents with Restrictive Eating Disorders by Optimizing Integrated Behavioral Health Care
• April 19, 12:00-01:00PM – Integrated Behavioral Health Meet and Eat
• April 24, 07:30-09:30AM – Asthma Collaborative
• April 25, 07:30-09:00AM – Demographic Data Collection Quality Improvement Meeting