Care Transformation Collaborative of RI
News & Updates | July 2022

Following the hard work of general assembly leaders to develop a FY2023 budget, Governor McKee officially signed the state’s new $13.6 billion budget into state law on June 27, making important investments to maintain Rhode Island’s economic momentum, while investing in key services and programs, from housing to health care.

Included in the budget, pediatric providers received an allocated increase through EOHHS, adding $2.5 million in general revenue and $3 million in federal funds to increase pediatric primary care rates from 33% to 100% of Medicare rates for fee-for-service (FFS) and from 65% to 100% for managed care. According to the Kaiser Foundation, prior to this increase, RI Medicaid had the lowest FFS pediatric rates relative to Medicare in the country, and notably, our neighbors’ FFS rates in MA and CT are currently about 75%. Rates above those neighboring states will help retain and attract more providers, and help to compensate for past underinvestment. Since more than half of children in RI (55%) are currently covered by Medicaid, it’s critical that providers are available for services such as developmental screening and vaccines, as well as referring children to services such as early intervention, behavioral health, and lead remediation services. 

The stabilization of funding and rate increases for pediatric primary care providers is a huge leap forward for Rhode Island and our primary care community. Thank you to our House of Representatives, Senate, and Governor for making this possible.

Following the state’s recent investment in pediatric care via the FY2023 budget, Dr. Elizabeth Lange, co-director of PCMH Kids and President of the RI Medical Society, weighs in on its significant impact for the pediatric care community and why rate parity was desperately needed. Dr. Lange is a pediatrician at Waterman Pediatrics/Coastal Medical.

What does this new policy change mean for pediatric practices in RI?
Rhode Island's Medicaid payment rates to pediatricians are the lowest in New England. Since more than 50% of our state's children are insured by Medicaid, these low rates dramatically impact the business plan of pediatric practices. The Affordable Care Act included two years of Medicare parity which, at the time, gave pediatricians the finances to provide comprehensive care and access to our patients. We truly appreciate the General Assembly's legislative support of children's healthcare with this pediatric rate increase.

Prior to the FY23 budget passing with a pediatric rate increase, what rate challenges or constraints were pediatricians facing?
An ideal pediatric medical home is fully staffed to comprehensively care for most children and family needs, and that model is not affordable under current RI Medicaid rates. In addition to the pediatrician, nurse practitioner or physician assistant, a dedicated patient care team (nurse care manager, parent consultant, social worker, care navigator, nutritionist, lactation consultant) is able to attend to the myriad of other needs that impact health. Thanks to the pediatric rate increase, over time pediatric offices will be able to hire the personnel needed to deliver complete care.

How will these rate changes impact families in Rhode Island and their pediatric care?
While many now view the COVID pandemic in the rear-view mirror, children and families are in a mental health crisis. The effects of isolation, loss of social interaction skills, Zoom school, as well as family financial and medical stress loom large in every pediatric exam room. With the support of pediatric Medicare rate parity, RI pediatric offices can equip with more resources to address the needs of our patients and families. Practices will be able to recruit new pediatricians to the area so that all children can have access to care in a comprehensive pediatric medical home.

On an exciting June evening, CTC-RI brought together providers, systems of care, primary care champions, health plans and partner agencies for a night of festivities at its Celebration of Champions. Held at Providence's Narragansett Brewery, the event honored the hard work and multiple accomplishments of our healthcare champions – 3 cohorts of PCMH Kids thus concluding the contract, participants from this year’s CTC-RI learning collaboratives, and all of our important and valued partners. Read more.
 
CTC-RI and PCMH Kids are pleased to offer 11 primary care practices the opportunity to apply for funding to participate in a 12-month Pediatric Health Initiative: “Improving Population Health and Addressing Health Disparity for Pediatric Weight Management by Optimizing Integrated Care” funded by Tufts Health Plan. Applications are due August 4.
 
This project aims to provide education and training to both practices who have an integrated behavioral health clinician on their team, and practices who do not have a clinician integrated into the practice so that both types of practices will be better equipped to intervene and positively impact children with weight management concerns. Up to 11 pediatric or family medicine practices will be selected to participate in this initiative.

CTC-RI and RIDOH, in collaboration with the URI College of Pharmacy, is pleased to offer primary care practices working within systems of care the opportunity to apply for funding to join a pharmacy quality improvement initiative that has been funded by UnitedHealthcare and RIDOH. Applications are due July 29.

CTC-RI will provide funding to support health care practices, working within systems of care, in their efforts to participate in a data-driven pharmacy quality improvement learning network initiative to improve the management of hypertension and diabetes through team-based care. The need for a pharmacy-specific learning network has grown out of the multi-payer, multi-stakeholder CTC-RI Clinical Strategy Committee and the RIDOH Pharmacy Workgroup, and is part of CTC-RI’s overall effort to assist primary care practice teams and systems of care with improving patient care. Up to 6 primary care practices will be selected to participate in this initiative.
 
CTC-RI/PCMH Kids, with funding from UnitedHealthCare and the RI Department of Health, is pleased to offer up 25 Nurse Care Managers/Care Coordinators (NCM/CC) the opportunity to participate in a standardized evidence-based training program in which you will learn to apply key care management concepts within your primary care practice setting and organization. Applications are due July 22.

The July quarterly PCMH Kids Stakeholder meeting, led by Drs. Beth Lange and Pat Flanagan, held space for participants to reflect on accomplishments, hear about past and continuing work, and discuss future priorities.
PCMH Kids convened in 2013 with a mission and vision to engage stakeholders in developing high-quality, family and patient centered medical homes so that RI’s children and youth could grow up healthy and reach their optimal potential.

Since then, PCMH Kids has engaged 36 practices covering 105,000 lives and representing more than 80% of the state’s pediatric Medicaid population to transform care to become team-based, data-driven, high-quality, value-based family-centered medical homes leading to National Committee of Quality Assurance (NCQA) Patient Centered Medical Home (PCMH) recognition. Read more.

CTC-RI, with support from RIDOH and Tufts Health Plan, is pleased to welcome new and continuing practices to the second Health Transition of Care Learning Collaborative. The June kickoff meeting had 26 participants representing the 4 pediatric and 3 adult practices who will be working to improve transition of care for youth and young adults, with and without special healthcare needs, as they transition from pediatric to adult care. Read more.

Recent accomplishments from the Transition of Care from Adolescent to Adult Healthcare Initiative were shared at the June Nurse Care Manager (NCM) / Care Coordinator (CC) Best Practice Sharing meeting, with a focus on the important role NCMs/CCs play in the process. Practices shared what they learned through the process and the National Alliance to Advance Adolescent Health provided an overview of the Got Transitions framework and tools to help practices successfully prepare youth for transition of care from adolescent to adult care. CTC-RI polled attendees on current practices and resource needs, then announced the NCM/CC Best Practice Sharing meeting was changing its name to “Best Practices in Team-Based Care." Read more.
(*Formerly known as Best Practices: Nurse Care Managers/Care Coordinators)
 
Join CTC-RI for the kickoff of our Best Practices in Team-Based Care ("It's All About the Relationship: How Connection in Primary Care Occurs Among Team Members") on July 19 from 8-9am via Zoom. In this meeting, Nelly Burdette, PsyD, Senior Director, Integrated Behavioral Health, Providence Community Health Centers will talk about the importance of relationships and connections in primary care teams.

The session will focus on defining team-based care through a health equity lens as it applies to high-functioning health care teams, reviewing best practices across five core values and skills for relational building in primary care and discuss what is working well and could be improved specific to relationship building in primary care among team members.

Please register to receive access to this virtual meeting. CEU credits will be available for those attending.

June’s Clinical Strategy brought together leaders in primary care to talk about “The State of Primary Care in RI Today and in the Next 10 years: Where are now and where are we going?” The panel was led by Jeffrey Borkan, MD, PhD, Brown University Chair of Family Medicine, Assistant Dean for Primary Care and Population Health, who shared data trends on the growing need for primary care providers in RI. Read more.

On September 9 at 7:30am, CTC-RI is excited to host Robert T. Jones, to talk about unconscious bias in healthcare. Mr. Jones is a multifaceted and competent consultant in the inclusion and diversity / organizational effectiveness industry. Formerly the Program Director for the National Conference for Community and Justice, RI and SE New England Region, Mr. Jones is the Chief Empowerment Officer of T. Lee Associates, an international education consulting company. He has conducted a wide range of strategic development sessions, workshops and trainings in a variety of settings for clients in Great Britain, India, over 150 high schools, 20 colleges and universities, various teaching organizations, religious organizations and small to Fortune 500 companies. Read more.

Last month, the Road to Equity teams came together to share and celebrate their first year project work, focused on an inequity issue within their communities. Based on the Pathways to Population Health Framework, this project has 6 participating teams made up of a health equity zone (HEZ) as well as other partners in the work: accountable entities, primary care clinics, community health teams, community-based organizations, community health workers and individuals with lived experience of inequities. Throughout the year, the teams were supported by coaches from RIDOH, CTC-RI, and the Wellbeing and Equity in the World (WE Team). Read more.

As part of our ongoing strategic planning process, CTC-RI devoted our June IBH Committee meeting to soliciting feedback from the behavioral health community about where to focus our energy over the upcoming year. Using attendee feedback, CTC-RI has created 4 IBH-related goals for the upcoming year:
  1. Increase by 75% the number of practices with NCQA BH Distinction by June 2023
  2. Support upcoming new OHIC Affordability Standards
  3. Collaborate with State MH/SUD initiatives that have the potential to interface with primary care
  4. Build primary care work force and practice capacity for BH integration and health equity

We will be continuing this planning process at our October 13 IBH Committee meeting. Read more.

CTC-RI is excited to announce that 11 behavioral health (BH) professionals graduated from the UMass Primary Care Behavioral Health course in May, representing 7 RI primary care practices, and supporting CTC-RI's effort to increase the number of BH providers trained in integrated BH (IBH) within the state.

The 3-month course was designed to support behavioral health professionals skilled at practicing specialty mental health to transition into working in primary care. Upon completion of the course, learners were given the opportunity to meet with one of our IBH practice facilitators to get support with concepts covered or begin IBH implementation at their workplace.

We will be offering another chance for BH professionals to complete this course in September. Read more.
Rhode Island COVID-19 Updates

COVID-19 Cases
COVID-19 cases have been continuing to decline over the last month. As of July 9, there were 156 new cases per 100,000, compared to 172 (July 2), 168 (June 25), and 185 (June 18).

COVID-19 Vaccines
As of July 13, 443,597 Rhode Islanders have received a booster vaccine (42.0%), 897,118 have completed their primary vaccine series (84.9%), and 1,065,624 are at least partially vaccinated (99.0%).
Practice Resources
Updates to NCQA PCMH Standards now available
NCQA updates Recognition publications periodically to clarify guidance, revise resources and refine criteria expectations. Updates are now available for the Patient-Centered Medical Home (PCMH) and Patient-Centered Specialty Practice (PCSP) standards and Annual Reporting publications.
Upcoming CTC-RI Committee Meetings and Workgroups
In order to respond to identified integrated learning priorities and provide Continuing Medical Education (CME) credits for MDs, DOs, NPs, PAs, RNs (and potentially pharmacists – who should check with their state regulatory body for particular activities), CTC-RI is restructuring many of its standing committee meetings as described below:

  • July 15, 07:30-09:00AM – Clinical Strategy Committee
  • July 19, 08:00-09:00AM – Best Practices in Team-Based Care (formerly Nurse Care Manager/Coordinator Best Practice Sharing)
  • July 22, 07:30-08:45AM – Board of Directors
  • August 16, 08:00-09:00AM – Best Practices in Team-Based Care (formerly Nurse Care Manager/Coordinator Best Practice Sharing) 
  • August 19, 07:30-09:00AM – Clinical Strategy Committee
  • August 26, 07:30-08:45AM – Board of Directors
Upcoming Learning Collaboratives and Professional Development
  • July 15, 11:00-12:00PM – Rhode to Equity Year 2 Kickoff Meeting
  • August 04, 07:30-08:00AM – Virtual Coffee Breaks with Dr Pat Flanagan & Dr Beth Lange
  • August 22, 12:00-01:00PM – Healthy Tomorrows Joint Meeting Cohorts 1 and 2
  • August 23, 07:30-09:00AM – Pharmacy QI Learning Collaborative: CGM & ABPM
Care Transformation Collaborative of RI | ctc-ri@ctc-ri.org | ctc-ri.org