Leveraging Medicaid in a Multi-Payer Medical Home Program: Spotlight on Rhode Island's Chronic Care Sustainability Initiative

Introduction

In recent years, a growing number of states have undertaken major delivery system reforms in Medicaid, seeking to improve care coordination and health outcomes for Medicaid beneficiaries, and to reduce spending growth in the program. To help inform the development of such initiatives in other places, the Kaiser Commission on Medicaid and the Uninsured worked with Mathematica Policy Research to examine key operational features of coordinated care initiatives in Medicaid in three states – Colorado, North Carolina, and Rhode Island. This issue brief focuses on Rhode Island’s Chronic Care Sustainability Initiative (CSI), a multi-payer, statewide patient-centered medical home (PCMH) initiative. Because Medicaid is the largest health care purchaser in the state, the program’s participation in Rhode Island’s initiative is one crucial source of its leverage.

The information and perspectives presented here are based on a review of CSI program documents and on telephone interviews with the program managers, two large participating health plans, and two participating practices with Medicaid patients — a community health center, and an office-based practice with both commercially-insured and Medicaid patients.