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Transforming Healthcare: Part II
By Larry Warner / November 2, 2016 /   Loading Disqus...
“We need approaches to the solutions that aren’t just arithmetic and additive, but are in some sense logarithmic. This will require us to reach across historic boundaries and unlock the potential of collaboration across the usual disciplines.”
– Jeffrey S. Flier, MD, former dean of the faculty of medicine, Harvard University

Among the strategies employed by the Rhode Island Foundation to improve access to and quality of primary care is to “identify, test, and spread innovative new approaches to healthcare”. One such approach is Bridging the (Health Equity) Gap, an initiative of Clínica Esperanza/Hope Clinic in Providence. Bridging the Gap is a proposed Pay for Success (PFS) program that will connect the pre-insured with healthcare, address health disparities, and reduce insured care costs in Rhode Island. PFS is a creative funding model where private investors pay up front for social services, and are reimbursed by governments with a return on investment if the services deliver their intended results. The government has no financial risk and spends less than it would have otherwise while achieving improved outcomes. PFS has great potential in the context of healthcare.

Access for the pre-insured

The pre-insured are low-income patients who have been legalized U.S. citizens for less than five years, and as such are not yet eligible for subsidized healthcare under the Affordable Care Act. Clinica Esperanza/Hope Clinic (CEHC) estimates that there are at least 5,000 pre-insured patients in Providence, many of whom attend their clinic at 60 Valley Street.


The intent of the Bridge the Gap program is to identify and recruit pre-insured patients with chronic health conditions, provide them with primary care, acute care, and health education with the goal of improving their health and health literacy by the time that they become eligible for Medicaid and/or Medicare. Based on a similar model in the state of New York and using local target enrollment numbers, CEHC estimates that Rhode Island would realize more than $1 million in net savings from their pilot. Assuming success, this model could be replicated at other sites that provide care to the pre-insured.

A Rhode Island Foundation strategy grant of $75,000 from the Healthy Lives sector has helped CEHC leverage additional private and state support for this initiative, and they have applied for matching federal support. This innovative approach to healthcare benefits the pre-insured by improving access to quality primary care and complements the work of healthcare transformation in our state.

Shared medical appointments

Another innovative approach to healthcare delivery is the shared medical appointment. Developed with a Foundation grant to the Women’s Medicine Collaborative, shared medical appointments are an innovative model of care that offer numerous benefits including improved access to care, increase in patient and provider satisfaction, and better health outcomes. A shared medical appointment (SMA) allows providers and patients to spend more time together, in collaboration with a multidisciplinary healthcare team, and in a more comprehensive manner than is typically experienced in a more time-constrained one-on-one setting.

In a typical 15-minute office visit, patients may feel rushed and may not be able to think of, ask, or get answers for all of their questions. However, in a 90-minute SMA, shared with individuals who are dealing with similar health issues such as asthma or diabetes, patients benefit from individualized care, observing their provider(s) interact with other patients, and supporting each other by sharing experiences. SMAs are not mandatory, and patients are still able to meet one-on-one with their provider. However, this innovative model for medical follow-up increases access to primary care providers, multidisciplinary care, education, and peer support.

The SMA model was shared with the medical community at a recent Lifestyle Medicine Symposium held at the Alpert Medical School at Brown University. Hosted by the Women’s Medicine Collaborative and Brown, the symposium was attended by primary care providers, family practitioners, internists, specialists, nurses, social workers, dietitians, and medical and nursing students. Participants learned about SMAs as well as other important topics, some in fulfillment of continuing medical education requirements. All participants left with a SMA Training Manual, which provides guidance on topics ranging from how to obtain stakeholder buy-in to the workflow of an SMA to measuring outcomes. The manual is a great resource for providers curious about or actively working toward implementing an SMA model at their medical practice.

From the Foundation’s perspective, the reward of investing in the successful development of innovative healthcare models is only surpassed by the developers of the model providing the blueprint for others to share in their success. This is truly a team approach to innovation. Health, healthcare, and healthcare reform are all team sports. In subsequent posts, we’ll take a look at other examples of how the Rhode Island Foundation and its community partners are working toward the goal of a patient-centered healthcare system with better health outcomes.


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