Rhode Island

Rhode Island has a long history and continued commitment to using the PCMH as the foundation for all health care improvement efforts in the State. In 1999, the Rhode Island Chronic Care Collaborative grew out of a partnering of the Rhode Island Department of Health Diabetes Prevention & Control Program and the Thundermist Health Center in the Bureau of Primary Health Care Health Disparities Collaborative for diabetes. Between 2000 and 2002 the Diabetes Prevention and Control Program created an in state collaborative with the addition of ten community health centers and one hospital-based practice. In 2003 the Diabetes Prevention and Control Program and Quality Partners of Rhode Island (now Healthcentric Advisors) received a grant from the Robert Wood Johnson Foundation’s Improving Chronic Illness Care program to train physician practice teams based on the Bureau’s Collaborative model.

Launched in 2008 by the Office of the Health Insurance Commissioner, the R.I. Chronic Care Sustainability Initiative (CSI-RI) brings together key health care stakeholders to promote care for patients with chronic illnesses through the patient-centered medical home (PCMH) model. CSI-RI began with five pilot sites in 2008, added eight sites in 2010 and another three sites in October 2012. Currently, over 85,000 Rhode Islanders receive their care from CSI-RI practices. Over the next five years, 20 practices will be added each year, with the goal of providing over 500,000 Rhode Islanders with access to a PCMH.

In July of 2011, Rhode Island passed 2011 S 770 – Rhode Island All-Payer Patient Centered Medical Home Act of 2011, which directed the Health Insurance Commissioner to create a Patient-Centered Medical Home Collaborative. The Collaborative conisted of various stakeholders including providers, insurers, patients, hospitals, and state agencies, and was required to develop a payment system that mandated all insurers to provide care coordination payments to PCMHs by July of 2012. The Act requires that the care coordination system be in place through at least July of 2016.

Rhode Island’s State Health Care Innovation Plan builds on the success of all these programs and include ongoing training and payment support for primary care practices transforming to PCMHs, integration of behavioral health in primary care, increased use of ACO's or ACO-like structures to align payment with quality, expanding the use of community health teams for high-risk populations, and continued development of analytic tools that can be leveraged by the State, providers, and payers.

For more detailed information about public programs in Rhode Island, visit the National Academy of State Health Policy.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Multi-Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Care Transformation Collaborative of Rhode Island (CTC)	Multi-Payer	Statewide	Multi-Payer Advanced Primary Care Practice (MAPCP)
Rhode Island Comprehensive Primary Care Plus	Multi-Payer	Statewide	CMS Comprehensive Primary Care Plus (CPC+)

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
CMS Health Care Innovation Award - Living Rite-A Disruptive Solution for Management of Chronic Care Disease	Grant	Statewide	CMS Health Care Innovation Award (Round 1)
CMS Health Care Innovation Award - Transition Home Plus Program	Grant	Statewide	CMS Health Care Innovation Award (Round 1)
CMS State Innovation Model (SIM) Test Award - Rhode Island	Grant	Statewide	CMS State Innovation Model (SIM)
Pediatric Practice Enhancement Project	Medicaid	Statewide
Rhode Island Health Homes	Medicaid	Statewide	ACA Section 2703 Health Homes
Rhode Island Integrated Care Initiative	Medicaid	Statewide	CMS Dual Eligible Demonstration

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
BCBS RI Patient Centered Medical Homes	Commercial	Statewide	Blue Cross Blue Shield Value-Based Care Program
UnitedHealthcare - Rhode Island Primary Care Physicians Corporation (RIPCPC) ACO	Commercial	Statewide
UnitedHealthcare Patient-Centered Medical Home Program- Rhode Island	Commercial		UnitedHealthcare PCMH Program

State Legislation

Legislation	Status	Year
2011 S 770 – Rhode Island All-Payer Patient Centered Medical Home Act of 2011 The Act directed the Health Insurance Commissioner to create a Patient-Centered Medical Home Collaborative. The Collaborative conisted of various stakeholders including providers, insurers, patients, hospitals, and state agencies, and was required to develop a payment system that mandated all insurers to provide care coordination payments to PCMHs by July of 2012. The Act requires that the care coordination system be in place through at least July of 2016.	Enacted	2011
Ch. 42-14.5 Authorizes Insurance Commissioner to set minimum PC spending target for state-regulated insurers; engage in practice transformation activities, as part of promoting Affordability Standards	Enacted	2004