R.I. Primary Care Transformation Adds Community Health Teams, Integrated Behavioral Health

Healthcare transformation efforts in Rhode Island are transitioning from the “patient-centered medical home” model to a more holistic and inclusive “comprehensive primary care” model using community health teams, integrated behavioral health, and expanding the capacity of primary care to treat patients with substance use disorders.

The 2019 Annual Report from the Care Transformation Collaborative of Rhode Island (CTC-RI) highlights progress made in 2019 and some future directions and goals. Legislation led to the creation of CTC-RI and made greater investment in primary care possible.

 One area of progress the report notes is addressing the state’s opioid crisis by normalizing conversations around substance and alcohol use. “Through collaborative work with the state and key agencies, we helped introduce and expand Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Rhode Island. In just one year of this intervention work, among those who initially reported illegal drug use, 53 percent reported no use six months later.”

Rhode Island is seeking to re-imagine the traditional settings for primary care with Integrated Behavioral Health (IBH) and Community Health Team (CHT) programs.

A 2019 analysis of the CHTs work shows significant reductions in patient health risk, depression, and anxiety after less than five months in care. The IBH program – where patients can receive behavioral health support from the comfort of their own practice – has reduced emergency department visits among other successes, the report says.

 Momentum also has been building in terms of transforming pediatric care in the state. “In just three years, we’ve created a statewide, multi-payer pediatric-sensitive primary care transformation initiative, which now includes 37 practices, covering over half the children in the state and 80 percent of Rhode Island Medicaid-insured children,” the report notes. “In spring 2019, the Rhode Island Foundation awarded us a $450,000 grant to test the implementation of integrated behavioral health at eight pediatric sites. We look forward to seeing this work lead to better outcomes while targeting Rhode Island communities disproportionately impacted by behavioral health issues.”

 In an introduction to the report, Thomas Bledsoe, M.D. president of CTC-RI’s board of directors, said the organization would continue to grow its statewide collaborative to gain better insight on what works, and share of best practices. It will support changes in primary care payment model to better sustain and support the expanded comprehensive primary care model. He saiid CTC-RI would also increase the capacity of primary care practices and systems of care in Rhode Island to provide more on-site integrated behavioral health services and better coordinate with community-based organizations to better address patient health-related social determinants of health.

Finally, the organization will continue to build the PCMH Kids practice model, address the needs of high-risk children and families through the already successful statewide community health teams and improve coordination with community linkages.

 “We believe that the core of reform starts with primary care,” Bledsoe wrote. “Our 128 practices and their care teams commit to this daily.”