Five Questions With: Andrea Galgay

Andrea Galgay was named chair in 2016 of Rhode Island’s State Innovation Model Steering Committee, which oversaw spending of a multiyear, $20 million grant from the Center for Medicare and Medicaid Innovation. Rhode Island received the grant in late 2014, and it became official in February 2015.

Galgay, who also serves as director of accountable care organization development for the Rhode Island Primary Care Physicians Corp., discusses the impact of programs supported by SIM. Grant money was distributed until June 30.

PBN: Can you provide a general sense of how the SIM funds were broken down? 

GALGAY: First, it’s important to know the background of the State Innovation Model Test Grant. Rhode Island received a sizable grant to invest in creative and affordable approaches toward improving the quality and delivery of health care here in Rhode Island.

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Partnering with state agencies, [such as] the Executive Office of Health and Human Services, the Office of the Health Insurance Commissioner, and HealthSource RI, organizations from across the state implemented a wide array of programming to transform our health care system and improve Rhode Island’s population health. The Steering Committee included health care providers, health insurance companies, community leaders and state agencies, all working together to improve the health of Rhode Island.

Rhode Island spent our SIM funds in four overall areas: investments in workforce and practice transformation – $7.55 million; patient engagement – $1.84 million; data analytics and health information technology – $6.16 million; increasing Rhode Island’s public and private culture of collaboration – $4.45 million.

PBN: What benefits did the landscape of Rhode Island’s health care see from the use of this money? 

GALGAY: While there is still a lot more work to do to transform our health care system, Rhode Island made great strides with our SIM dollars. We had the responsibility of delicately balancing our investments across key initiatives that affect a wide spectrum of Rhode Islanders. A large part of our work focused on health system transformation – moving our system from one based on volume to one based on value. This included creating and implementing a set of aligned quality metrics and other programs focused on children, end-of-life, chronic care management, and population health.

I also think that the community engagement piece is pivotal. Often, in the nonprofit community you may have two or three nonprofit organizations in a pretty small catchment area doing slight variations on the theme of the same project. That came to light at vendor meetings where vendors would speak to each other and then find ways to collaborate on nonSIM-related initiatives. I think it built those relationships that are going to be long-lasting and broke down barriers across the vendors within the state.

We also saw that culture of collaboration at the steering committee level. Now, the steering committee members have a better understanding of what the state agencies are doing and how they are working together to support health care improvements in the state. Many of the people that are around the steering committee table may not have had that insight, because in their jobs, they’re just so far removed from the work of state agencies. That awareness would have been lost if it were not for the steering committee and SIM in general.

PBN: SIM’s health focus areas are obesity, tobacco, chronic disease, depression, social and emotional disturbances in children, serious mental illness, opioids and maternal and child health. Have any of these areas seen specific benefits as a result of the SIM grant?

GALGAY: The point of SIM was to test different health care models. Some of those models focused on maximizing preventive care and others focus on different strategies, [such as] integrating physical and behavioral health, increasing data analytic capacities, and strengthening ties between clinical settings and local communities. Within these strategies, we did focus on a variety of specific health areas, [such as] obesity, behavioral health and chronic disease.

For example, we spent a significant amount of money and time focused on increasing access to, and integrating behavioral health into, the primary care setting. The Pedi-RPN program at the Emma Pendleton Bradley Hospital encourages pediatricians to consult with mental health experts through a phone call to help improve access to high-quality mental health services. This improves children’s health and addresses children with social and emotional disturbances.

We learned from states that have done similar initiatives – and we have been eager to use what we’ve learned to bring the project to scale and implement it elsewhere. For example, the R.I. Department of Health has successfully launched MomsPRN, which addresses maternal health and depression. The program helps obstetricians with their patients who need behavioral health services, using a new federal grant.

Our community health teams initiative is another great example, with their focus on patients at highest risk for medical issues and those with the most intense need for social service assistance. Working with the Care Transformation Collaborative and their many community partners, we started with a very heavy patient-centered medical home model where all the resources were embedded in the practices. Then we layered the Community Health Team on top of that.

Community Health Teams include community health workers, behavioral health providers, other clinical providers – [such as] nurse care managers – and they have access to services [such as] nutrition, pharmacy and legal assistance. Through this project, we helped strengthen the primary care practices that used the teams’ services and the teams helped address people with chronic illnesses. Through funding from Rhode Island’s Medicaid Health System Transformation Project, the State Opioid Response Grant and insurance carriers, the community health teams are sustained and will expand.

We have data to show the value of each of these projects and in some cases, how they have improved health risk scores, but it’s too early to have measured significant improvement in these specific health areas.

PBN: How much attention was given to preventative health measures as a way of cutting health care costs? 

GALGAY: A number of the projects we carried out as part of the process of testing these strategic models focused on prevention. The Community Health Team Project was braided with our SBIRT project, which stands for Screening, Brief Intervention, and Referral to Treatment. The SBIRT project is aimed at addressing substance use and mental health disorders throughout Rhode Island. Working with primary care providers, the project is carrying out SBIRT screenings throughout the state in primary care, hospital emergency departments, in the community and has worked in the Department of Corrections, too.

By screening people for substance use, and using motivational interviewing and other treatment strategies, the participating agencies have helped lower rates of substance use in the state. The funding from both, and SIM, aims to better support patients and improve population health by increasing access to community services and resources to address social, behavioral, environmental, and/or complex medical needs.

Another key component of prevention is the investment that RI SIM made in Rhode Island’s Health Equity Zones. This mission of the HEZs [is] to encourage and equip neighbors and community partners to collaborate to create healthy places for people to live, learn, work and play. These strong communities are a key prevention strategy for a range of physical and behavioral health issues.

PBN: Will patients in Rhode Island see any change in their health care expenses as a result of the work of the SIM Steering Committee?

GALGAY: All of the work RI SIM focused on to integrate physical and behavioral health is aimed at increasing quality and reducing the cost of care. In preliminary data and certainly in anecdotal evidence, Community Health Teams reduce the number of unnecessary emergency department visits. Pedi-PRN also allows young people with behavioral health issues to get care in their pediatrician or primary care physician’s office and not at a more expensive setting. The Integrated Behavioral Health Project has data showing reductions in cost and increases in the quality of care – less time in the [emergency department] and in the hospital for patients, and lower total medical or pharmacy costs.

The Health Information Technology projects help streamline work in the provider office and support more quality care. Other HIT work that SIM supported with assistance but not dollars, [such as] our Health Information Exchange, called CurrentCare, does lead to less duplication of services and thus lower costs.

Also, RI SIM supported the work of the Office of the Health Insurance Commissioner, which is responsible for regulatory measures that hold down the cost of care, including its work on the Cost Trend Project. On Dec. 19, 2018, members of the Healthcare Cost Trends Steering Committee signed the “Compact to Reduce the Growth in Health Care Costs and State Health Care Spending in Rhode Island,” which aims to hold costs to Rhode Island’s potential gross state product. PGSP is the total value of the goods produced and services provided in a state at a constant inflation rate and is 3.2%.

Many of RI SIM’s other projects will result in longer-term quality improvements and patient engagement, including our investments in improving end-of-life decision-making for Rhode Islanders.

Elizabeth Graham is a PBN staff writer. You can email her at graham@PBN.com.