NASHP Webcast

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NASHP Webcast Role of FQHCs in State-led Medical
Home Collaboratives June 11, 2009 Deidre S.
Gifford, MD, MPH Project Director RI Chronic Care
Sustainability Initiative (CSI RI) Jane A.
Hayward President CEO, RIHCA
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What is CSI RI?

• Multi-stakeholder collaboration
• Resulted in a 2 year multi-payer payment pilot
  and demonstration of the Patient-Centered Medical
  Home
• Funded by grant from the Center for Healthcare
  Strategies to RI Office of the Health Insurance
  Commissioner and RI QIO
• Began July 2006

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Stakeholders

• Payers (representing 67 of insured residents)
• Medicaid all RI-based commercial payers (Blue
  Cross Blue Shield of Rhode Island,, United
  HealthCare New England, Tufts Health Plan)
  Neighborhood Health Plan of Rhode Island
• Purchasers (including 70,000 self-insured
  residents)
• The two largest private sector employers (Care
  New England, Lifespan) Rhode Island Medicaid,
  State Employees - health benefits program, Rhode
  Island Business Group on Health
• Providers
• Largest primary care provider organizations
  (including Community Health Centers, PCA, and
  hospital based clinics), Rhode Island Medical
  Society, RI AAFP, RI ACP
• State
• Office of the Health Insurance Commissioner,
  Department of Human Services, Department of
  Health
• Technical Experts
• Department of Health Quality Improvement
  Organization

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Scope of the Pilot

• 5 sites
• One CHC
• Two Family Medicine
• One large-volume Medicaid
• Two Internal Medicine
• One Academic practice
• Includes Nurse practitioners who bill
  independently
• 28 Providers (3-8 per site)
• 28,000 covered patients
• Standard contract language across plans and sites
• 2 years, beginning October 2008

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Pilot Elements

• Providers
• Implement components of patient-centered medical
  home (NCQA PPC-PCMH standards)
• Achieve Level I PCMH recognition by 6 months
• Achieve Level II PCMH recognition by 18 months
• Participate in local chronic care collaborative
  (Wagner Model)
• Measure and report quality in 3 chronic
  conditions (diabetes, CAD, depression) using
  registry or EMR
• Patient engagement and education

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Pilot Elements, cont.

• Plans
• Supplemental payment of 3 pmpm for all members
  (125k -325k per site per year)
• Pay costs of nurse care managers employed by
  sites
• Using a common format, feedback data on patient
  panels, chronic conditions and cost/utilization
• 1.2 mil total annual investment

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Pilot Elements, cont.

• All stakeholders
• Participate in on-going monitoring, oversight and
  future planning
• Large self insured employers
• Pay for programs for their workers
• Third Party Evaluation
• Drs. Schneider and Rosenthal, Harvard School of
  Public Health, funded by The Commonwealth Fund

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RIHCA

• Primary Care Association
• 10 organizational members
• 8 330 funded FQHC
• 1 FQHC look-a-like
• 1 island-based
• Served 112,000 unique patients in 2008
• 400,000 patient visits

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Collaborative Involvement and History

• All 330 health centers participated in HRSA
  Health Disparities Collaborative.
• Collaborative work continues today supported by
  limited state funds and health centers ongoing
  commitment.
• Rhode Island Chronic Care Collaborative (RICCC)
  established 2003.

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Health Centers and CSI-RI

• RIHCA participated in Steering Committee from its
  inception.
• Health centers well-positioned to participate
  given history with HRSA and state collaboratives.
• Thundermist Health Center selected as one of five
  pilot sites focus on Woonsocket adult medicine.
• Clinical focus of CSI-RI
• Diabetes
• Depression
• Coronary Artery Disease

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Thundermist Strengths

• EMR
• Experienced in chronic care model of delivery.
• Eager to participate in a payment model that
  recognized the added value of a patient centered
  approach.
• Previous ongoing collaborative work led to a
  culture that embraced CSI-RI.

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Thundermist Challenges

• NCQA accreditation submission required
  significant time and resource commitment.
• Significant investment in committee structure and
  work.
• Development of templates in EMR to capture
  elements related to clinical measures is still
  ongoing.

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Lessons Learned

• RICCC serving as the training arm of CSI-RI
  allowed for a level of familiarity as well as a
  great resource to Thundermist.
• Health Insurance Commissioner's involvement
  facilitated participation of the payers.
• RIHCAs early involvement allowed us to provide
  input on the structure of the pilot.
• Assigning a dedicated mentor to each pilot site
  provides a valuable resource to participants.
• RIHCAs involvement better positions us to
  support subsequent health center participants.

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• Thank you
• Deidre_Gifford_at_brown.edu
• jhayward_at_richa.org