Prevention Connection Newsletter

CSI-Rhode Island (Chronic Care Sustainability Initiative) is a multi-payer funded program whose aim is to "align care-delivery standards and financial incentives among the state's health plans (including Medicaid), purchasers, and providers with the goal of improving the delivery of primary care services to those with chronic illness" (original. emphasis). Funds provided through a Regional Quality Initiative grant from the Center for Health Care Strategies (CHCS) allowed the CSI-RI stakeholders to meet on a regular basis for two years leading up to the project kickoff October 1st, 2008. During this planning phase, agreement was reached on a wide variety of issues including: patient attribution, amount and methodology of payment to the pilot practices, which chronic conditions to focus on and which specific quality indicators to utilize. Additionally, it was decided that each practice would be apportioned a Nurse Care Manager (NCM), and that the NCQA PPC-PCMH(1) Recognition Standards would be used to gauge transformation of the practices toward a Patient-Centered Medical Home (PCMH)[1,2].

1. National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home
2. IHI- Institute for Healthcare Improvement

Clearly, the major difference between the RICCC and CSI-RI is the level of funding. Whereas an RICCC team would receive a small check for exemplary performance over the previous quarter, CSI-RI teams receive a per member per month (PMPM) fee that is more than an order of magnitude greater than that payed out in the RICCC. This alone resulted in the ready engagement of an entire group of physicians in a practice. In contrast to this, the RICCC depended on a physician champion to do the early improvement work and preach the value of it to the rest of the provider group. With wholesale buy-in from physicians in CSI-RI, rapid improvement in quality of care measures can be attained because of a collaborative approach that is created and supported within the practice.
In addition, the provision of a Nurse Care Manager (NCM) has been highly valued by CSI-RI practice physicians. In CSI-RI, the NCM is located on site in the practice. She is a broadly trained (diabetes, cardiovascular, smoking cessation, behavior change) provider who is able to work in close coordination with the primary care providers in the practice. She is able to provide face-to-face consultations, telephonic support, or run group visits. She is able to follow- up on emergency room visits and hospitalizations to try and minimize these costly encounters.
Click here to learn more about the successes of this project, how it has enhanced care provided to the patient, as well as, the positive effects across the practice workplace by reading this article in it's entirety.