URI in push for coordinated care

ALL ACCESS: Cathy Silva, program director of AccessPoint RI, talks with volunteer Brian Imondi. AccessPoint will host a URI program funded with a $14 million grant. / PBN PHOTO/DAVID LEVESQUE
ALL ACCESS: Cathy Silva, program director of AccessPoint RI, talks with volunteer Brian Imondi. AccessPoint will host a URI program funded with a $14 million grant. / PBN PHOTO/DAVID LEVESQUE

Before the individual mandate is ever enforced or insurance exchanges established, the federal health care reform law that’s roiled the nation may fundamentally change the way Rhode Islanders with cognitive disabilities and Alzheimer’s disease are treated.
Through its support of experimental ways of reducing health care costs, the Patient Protection and Affordable Care Act is sending $14 million to a University of Rhode Island program for coordinating care – and the teaching of care – for the cognitively challenged.
Over the three-year grant period, a URI team led by associate research professor Elaina Goldstein will set up two “Living Rite” clinics at centers for the disabled where a new system of integrated care will be tested.
The clinics follow the emerging “integrated” care model where treatment is coordinated between specialists and aimed at improving overall patient health, instead of the traditional model focused on providing individual services.
Instead of being in a hospital or doctor’s office, the clinics will be at centers, like AccessPoint RI (the former Cranston ARC), where people with cognitive disabilities already go for recreation, adult day care or to work.
“People with developmental disabilities and Alzheimer’s are coming to these places five times a week for recreation and activities and preventative health care,” Goldstein said. “Now we are talking about how they can get their chronic care.”
And the new clinics will be equipped with the latest in “telemedicine” equipment that allows the staff to not only communicate with physicians and specialists in remote locations, but provide them with images, such as scans, and data that allow diagnosis and consultation. The clinics will be designed by Ximedica of Providence with telemedicine equipment coming from Nalari Health of Providence. The idea is that by coordinating care in locations where patients with cognitive disabilities already go, the treatment of chronic conditions can be made more efficient and costly hospitalizations reduced.
URI estimates that the program will ultimately save $29 million ($15 million if you subtract the grant itself) in reduced care over three years.
“Primary care and physician’s offices were not set up for chronic-care management – it was set up for preventive and some acute episodes,” Goldstein said. “You need to create something different and it is better for them to be getting services where they are already coming. The emergency room is very expensive, not just for the hospital, but in taking staff out of the building. That shouldn’t happen now with telemedicine.”
But the URI plan goes beyond setting up new clinics and is ultimately aimed at promoting integrated care throughout the health care system.
That involves teaching and after the Living Rite centers are up and running, the grant will help pay for URI to establish a new interdisciplinary “Disability Health Center” at the school teaching students of all different specialties, such as nursing, medicine, pharmacy and social work, how to work together on patient care.
“Our hope is to make URI an interdisciplinary training center where students can get certified and people who are being trained in any kind of medical profession can get their interdisciplinary course-load,” Goldstein said. “Before they start practicing, this is an opportunity for them to work as a team.”
In addition to reducing health care costs by better coordinating the medicines and treatments patients receive, the interdisciplinary curriculum will help care providers teach patients how to best manage their care themselves. Along those lines, the grant includes setting up an employment program that will train, educate and place users of the Living Rite centers in jobs within the health care sector.
“In addition to being a medical demonstration project, part of this is developing job opportunities for people with disabilities,” said Thomas Kane, president and CEO of AccessPoint RI, which already runs employment programs for people with disabilities. “I don’t know if the unemployment rate in Rhode Island counts people with cognitive disabilities, but nationally it is 75 percent to 80 percent.”
The grant will fund health care sector job training, education and job placement for 21 people with cognitive disabilities.
In total, the program is anticipated to create 31 jobs, including 14 health professionals for the clinic staffs, eight peer wellness coaches (from among the Living Rite users) and five administrative staffers at the Living Rite centers. At URI, the grant will pay for two researchers, an assistant and a business manager to handle the grant.
The $14 million URI grant is one of 81 made so far by the U.S. Department of Health and Human Services out of a $1 billion Affordable Care Act pot.
The only other Rhode Island grant was to Woman & Infants Hospital in Providence for support for preterm babies.
Initially, the Living Rite program is expected to serve 950 people with Alzheimer’s or developmental disabilities, but Goldstein said if all goes well she hopes two more sites can be added, which would boost the patient count up to 1,900. •

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