1. Debra Hurwitz, MBA, BSN, RN CTC-RI Co-director October 20, 2016
Care Transformation Collaborative of Rhode Island Evidence of Practicing with Value: CTC-RI Perspective
Debra Hurwitz, MBA, BSN, RN
CTC-RI Co-director
October 20, 2016

2. CTC-RI Practicing with Value: Making a Difference in Cost of Care: Reducing In-Patient Admissions

3. All-Cause Admissions: All CTC-RI Cohorts** Reduced IP Admission Rates vs. Comparison
*Includes BCBS-RI, UHC, NHP data. Does not include Medicaid FFS or Medicare FFS data or RHO Dual Eligible NHP members.
**Refer to Appendix for list of practices per cohort

4. All-cause Inpatient Admissions per 1000 Member Months…..CTC Target= 5%
Group
July '13 – June '14
July '14 – June '15
Difference
% Difference
Difference Relative to Comparison*
(A)
(B)
(B-A)
Comparison
6.9
7.4
0.5
7.0% -
CTC Cohort 1
5.8
0.0
0.0%
-7.0%
CTC Cohort 2
6.6
6.7
0.1
1.0%
-6.0%
CTC Cohort 3
6.0
0.2
3.3%
-3.7%
Observation: the longer the practice cohort has been
in CTC, the greater the relative reduction in IP admissions
…….suggesting that transformation is hard work and takes time.

5. CTC-RI Practices Demonstrate In-Patient Savings > than program costs for FY2015
Difference in Admissions/1000 MM
1.15
Total CTC Member Months
1,538,538
Difference in number of Admissions (1.15 x 1,538,538 MM/1000)
1769
Average Cost per Admission *
$ ,000
CTC Savings
$       21,231,824
Total Program costs **
$       15,754,793
Net Savings
$ ,477,031
*Cost per Admission = 60th percentile; vs mean=$14k; Median=$10k
**Total Program Cost include CTC Admin, CHTs and Practice Payments paid by health plans

6. CTC-RI Practicing with Value: Making a Difference with Quality

7. Clinical Quality CTC Outperform Regional Benchmarks

8. CTC-RI Practicing with Value: Making a Difference with Customer Experience

9. 2014 MAPCP CAHPS Patient Experience Data Provider Communication statistically significant and Better Than All Other States – Note: This measure is a performance incentive in the CTC contract

10. 2014 MAPCP CAHPS Patient Experience Data- Access Approaching Statistical Significance and Better Than All Other States

11. CTC-RI Practicing with Value: Integrated Behavioral Health

12. Integrated Behavioral Health Pilot* (Phase1): 12 Practices
Assessment of Behavioral Health Integration
Intervention : monthly on site consultation provided by Dr. Burdette
Evaluation: Practices used the Maine Site Assessment to re-measure behavioral health integration in primary care
*Made possible through funding from Tufts health care

13. Maine Site Assessment -Evidence Based Tool
Average for All Dimensions (18)
Average Maine assessment score across all 18 dimensions
Pre-intervention average: 2.73
Post-intervention average: 3.49
CHANGE = 0.76

14. Integrated Behavioral Health Phase 2* – 12 practices
Intervention
On Site embedded Behavioral Health Staff
Monthly on site consultation
Staff training : universal screening for depression; anxiety and substance use disorder
Patient Care:
BH providers provides counseling mild to moderate depression; anxiety and SUD
Referral and care coordination for more complex cases to specialty BH
NCM Coordination with complex patients
*Made possible through Rhode Island Foundation and Tufts Health Car Funding

15. CTC-RI Practicing with Value: Community Health Teams

16. Community Health Teams: Program Development
2014 -Implemented Pilot with 2 teams
2015 -Evaluation of Pilot*
Phase 2 : Centralized Management and IT (
*Formative Evaluation conducted by Brown University Faculty)

17. What Did Patients Say? Whatever was needed: Behavioral Health
Food, clothing, furniture, medication……
Assistance with medical system and getting benefits
Behavioral Health
Moral Support and anxiety reduction
Encouragement to ask for help

18. Community Health Team Phase 2
Right Patient: Use of Standardized Triage Tool
Right Time: Direct Alert Notification;
Health plan communication
Right Data: Common data base to track results

19. Rhode Island: Practicing with Value: Moving Forward: OHIC Sustainability Payment CTC Expansion Comprehensive Primary Care Plus Accountable Care Organizations Transforming Clinical Practice Initiative