Chronic Care Sustainability Initiative: transforming the delivery of healthcare in Rhode Island
It’s a vision we can all aspire to: “Rhode Islanders enjoy excellent health and quality of life. They are active participants in an affordable, integrated health care system that promotes wellness and delivers high quality, comprehensive primary care.”
The Rhode Island Chronic Care Sustainability Initiative (CSI-RI) is working to make this vision a reality. Established in 2006 by Health Insurance Commissioner Chris Koller, CSI-RI brings together the key players in healthcare – physicians/other care providers, insurers, and consumers – to focus on prevention, wellness, and appropriate treatment.
The effort is based on the patient-centered medical home (PCMH) model that incorporates coordination of care, accessibility, and a team approach. It is especially effective in supporting people with chronic diseases, such as diabetes, heart disease, and depression.
|David Keller, MD, co-director of CSI-RI, at a primary health convening at the Foundation. |
David Keller, MD, co-director of CSI-RI, notes three key elements of the PCMH model. First is a nurse care manager who coordinates each patient’s care; second is a commitment to measurable quality improvements, an objective that requires system-wide electronic medical records; and third is adherence to a team-based approach.
“The team-based approach is essential to the PCMH model,” states Co-Director Debra Hurwitz, MBA, BSN, RN. “It assures that everyone is working to the maximum of their licensure and delivering the best care possible."
Under the leadership of founding Director Diedre Gifford MD, CSI-RI expanded from five pilot sites in 2006, to 13 sites serving more than 70,000 patients in 2010. Now it serves 16 sites with more than 86,000 patients. “We’re closing in on serving 10% of the state,” Hurwitz explains.
|Debra Hurwitz, MBA, BSN, RN, co-director of CSI-RI (right), talks with Kathleen Hittner, MD, following a health panel Dr. Hittner moderated at the Foundation. |
“And it would not surprise me if we’re able to double the program within a year or two. The state is very committed to reforming the health care system, and it’s pretty clear the insurance industry wants to go in this direction. This investment in primary care is paying off for the insurers,” Dr. Keller states, noting the voluntary participation in CSI-RI of all major healthcare insurers in the state.
The PCMH approach also is beneficial to both providers and consumers. “Care providers are better able to understand how they’re affecting the health of the population they serve. All the doctors in the CSI-RI practices want to do a better job of caring for their patients. This model has been very rewarding for them,” Dr. Keller points out.
Consumers have benefited through increased access to care, better coordination of their care, and ultimately improved health.
|CSI-RI is based on the patient-centered medical home (PCMH) model.|
CSI-RI also has benefited from synergy with other initiatives within the state, especially with the Beacon Initiative of the Rhode Island Quality Institute. “Without real-time data, practice transformation can’t happen”, states Dr. Keller. “Fortunately, Rhode Island is a national leader in that area”.
In addition to adding more practices in the years ahead, Dr. Keller outlines three potential new directions for CSI-RI: community-based health teams especially for solo and two-physician practices; a PCMH model for children that would focus on preventing chronic illnesses, rather than managing them; and further integration of behavioral health care.
“CSI-RI truly is transforming the delivery of primary care in Rhode Island. Its participating practices are delivering an improved quality of care, at lower costs, and with better health outcomes. We look forward to the further expansion of this program,” shares Yvette Mendez, grant programs officer for health at the Foundation.
In addition to its support for CSI-RI, which includes office space at One Union Station, the Foundation has provided funding to assist two providers to prepare for participation in the CSI-RI initiative. A grant to the Blackstone Valley Community Health Center in 2010 helped this Pawtucket-based provider implement the PCMH model; it was one of three practices to join CSI-RI in 2012.
|The PCMH model incorporates a team approach to patient care.|
A Foundation grant, also in 2010, to the South County Hospital Healthcare System has helped the Hospital and six community primary care practices develop a Patient Centered Medical Community as part of CSI-RI. Currently, six of the 16 CSI-RI providers are in South (Washington) County.
“Much of the work we do takes existing community resources and aligns them in a different way,” Dr. Keller states, adding, “And Debra and I are having a blast because Rhode Island is perfectly prepared, wonderfully collaborative and ready to embrace this cutting edge approach to the practice of medicine.”