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About the CSI-RI Medical Home Demonstration

The CSI-RI Medical Home demonstration officially launched in October 2008 with 5 primary care practices, one of which was Coastal Medical Greenville. The program was expanded in April 2010 to include an additional 8 sites, one of which was Coastal Medical Wakefield. Thirteen primary care sites, 66 providers, 39 Family Medicine residents, 68,000 patients (46,000 covered lives), and all Rhode Island payers are participating in the demonstration. Further, its selection to participate in the Centers for Medicare and Medicaid Services' Multi-Payer Advanced Primary Care Practice demonstration, CSI-RI is one of a few medical home demonstrations in the nation with virtually 100% payer participation.

Since the start of the demonstration, CSI-RI sites have implemented a series of delivery system reforms in their practices, aimed at becoming "medical homes," and in turn receive a supplemental per-member-per-month payment from all of Rhode Island's insurers. Each participating practice site also receives funding from participating payers for an on-site nurse care manager who can see all patients in the practice, regardless of insurance type or status.

As a condition of participation, providers, staff, and care managers receive training and technical assistance activities organized by a designated practice support vendor. Practices report quarterly from an EMR or electronic registry on a standardized set of diabetes, coronary artery disease, and depression clinical measures. Health plans are required to provide practices with patient-level data on emergency department and inpatient utilization. Health plans also report quarterly at a project-level on a uniform set of cost and utilization measures. Per contractual requirement, all 5 original pilot sites achieved NCQA level 1 PPC-PCMH recognition in 2009, and all 8 expansion sites achieved at least level 1 PPC-PCMH recognition in 2010. As of December 2010, all of the pilot sites and two of the expansion sites have been recognized by NCQA as level 3 patient-centered medical homes.