What began as a pilot program five years ago, the Chronic Care Sustainability Initiative of Rhode Island (CSI-RI), now includes 16 practices and covers nearly 10 percent of the state’s population. The Initiative has been in the forefront in the adoption of the patient-centered medical home model and its team approach to health care in Rhode Island. Providence Business News asked co-director Debra Hurwitz to talk about how the Initiative has helped reshape the delivery of health care in Rhode Island.
PBN: How many practices and how many patients are now involved with the CSI-RI initiative? Are there future plans to expand even further?
HURWITZ: The Initiative began as a pilot and has grown over time. Currently, 16 provider practices that serve more than 80,000 patients are participating in the Initiative.
We recently added 13,500 of those patients when three additional practices were selected to join the Initiative in October. We now cover nearly 10 percent of the state’s population.
We have learned a lot over the past five years and hope to expand the Initiative in 2013.
We believe that every Rhode Islander should benefit from the quality of care that is provided by a patient-centered medical home.
PBN: One of the new “recruits” to the CSI-RI initiative, Blackstone Valley Community Health Center, has done a remarkable job in bending the medical cost curve while at the same time improving health outcomes by integrating data at the point of health care delivery. How does the CSI-RI initiative plan to incorporate and benchmark Blackstone Valley's successes?
HURWITZ: The key to CSI-RI’s success is collaborative learning, the idea that the practices and health plans learn together how to provide health care that meets the “triple aim”: better quality, better patient experience and lower cost.
When we expanded CSI-RI last spring, we were looking for practices like Blackstone Valley, which has a track record of innovation, to bring new ideas to that collaborative effort.
Blackstone Valley has made significant internal investments in data systems that enable them to combine clinical and claims data into a rich data source for clinical decision-making and quality improvement.
We are excited to have Blackstone join the Initiative and look forward to enhancing this learning collaborative.
PBN: In a presentation at Brown University earlier this year, Dr. Douglas Eby, a physician with the Alaskan Native Medical Center, said that one of the keys to his health center's success as a patient-centered medical home was the explicit direction given to providers to learn to listen in 10 different ways when talking with patients. Do you use similar training directives for its doctors, nurses and physicians' assistants?
HURWITZ: The patient-centered medical home model places the patient and family at the center of attention. Shared decision-making is a hallmark of the model – doctors and nurses work closely with patients to ensure that they understand their condition and the treatment options that work best for them.
Understanding what patients need, what they want and what they are ready to accept, is critical to achieving positive health outcomes. Skilled practitioners ask open-ended questions and engage in active listening and dialogue with patients.
We know the best outcomes are achieved when a patient is activated and engaged in their own health care. CSI-RI supports best practice sharing sessions for physicians, nurses and practice staff.
The beauty of CSI-RI is that our practices have all found different ways to reach the goal of improved communication, and they then share their methods in our learning collaborative. We set the goal of improved communication, measure the outcome through patient surveys, and the practices try different ways of achieving the goal. When we set goals in preventive care and chronic disease management, we see similar results.
After the think tank at Brown University last year, we integrated Dr. Eby’s approach. We will continue to add any other good ideas and best practices that we find along the way.
PBN: Much of the current work of the CSI-RI initiative is focused on creating a team approach in caring for adults who have – or may be at risk – for chronic diseases. What plans, if any, are there to build out and broaden the program to include pediatrics?
HURWITZ: The medical of home model of care actually began in pediatric practices 20 years ago, to create systems in which providers could focus on preventive care and manage children with special health care needs. CSI-RI focused on adults, especially during the pilot phase, because adult primary care was struggling. The patient-centered medical home has created practices in which generalists, rather than specialists, can focus on prevention and the care of adults with chronic diseases.
However, the model works for all ages. One of our goals is to bring children into the program and we are currently working with the state to develop a plan to do so in the near future.
PBN: As more and more group practices evolve in Rhode Island into patient-centered medical homes, how important will be the development of shared savings contracts with health insurers so that the practices can share in the financial benefits of cutting medical costs?
HURWITZ: CSI-RI is an inclusive initiative that has broad stakeholder engagement and involvement. We are proud to have 100-percent payer participation, including Blue Cross and Blue Shield of Rhode Island, Medicare, Medicaid, Neighborhood Health Plan of Rhode Island, Tufts Health Plan and UnitedHealthcare.
Our state’s payers are committed to this model – and as we see more positive results, including increases in patient engagement, enhanced access and communication, and better care management, it will be important to look at different contract and plan options so that payers, providers and patients can share in the benefits and rewards of the patient-centered medical home.
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