RI AHEAD Model Funding Opportunity - The Rhode Island (RI) Executive Office of Health and Human Services (EOHHS), a cabinet-level agency that directly reports to the Governor, will lead the state’s overall AHEAD Model statewide development and implementation. As the single State Medicaid agency and the agency responsible for coordinating the organization, finance, and delivery of services and supports provided through the Departments of Children, Youth and Families; Health; Human Services; and Behavioral Healthcare, Developmental Disabilities, and Hospitals, EOHHS is well-positioned to ensure alignment of statewide health care delivery system reforms and AHEAD Model success to advance and improve RI’s healthcare system. EOHHS will be responsible for overall grants management and reporting, and for achieving the following project goals: developing and implementing the Medicaid Primary Care alternative payment model (APM) and hospital global budget (HGB) payment model; recruiting primary care providers to participate in the APM; and creating a strong interagency and public/private Model Governance Structure (MGS) to oversee the establishment of Medicare and all-payer total cost of care (TCOC) and primary care investment targets, and statewide quality and health equity targets. The RI Office of the Health Insurance Commissioner (OHIC), the state’s commercial health insurance policy reform and regulatory enforcement agency, will be a key interagency partner on the Cooperative Agreement award. OHIC will co-lead the MGS with EOHHS and the establishment of the Medicare and all-payer TCOC and primary care investment targets and the statewide quality and health equity targets; help develop the commercial HGB payment model with participating insurers; coordinate with EOHHS on provider recruitment for the APM and HGB payment model; and help lead measurement and reporting. The Cooperative Agreement Project budget is $2,000,000/year for six years and will be spent on increasing RI Medicaid’s capacity for overall Cooperative Agreement oversight and for developing and implementing the APM and HGB; supporting the state’s data analytic needs for the program; and longer-term, supporting community participation in the program and in addressing health equity and quality. Funds will also be used to support OHIC’s project work. RI’s Medicaid program has long been recognized as a leader in delivery system reform. Over the last 16 years, RI has harnessed its comprehensive 1115 waiver to implement innovative programs. RI Medicaid has also consistently achieved or exceeded key quality and performance metrics. OHIC leverages its Affordability Standards – a set of requirements for commercial insurers to improve health care affordability – to drive payment reform, among other policy objectives. Through these standards, OHIC requires insurers to limit growth in hospital payment rates to an affordable level; increase their investments in primary care services through an annual insurer spending obligation; and make practice support payments to support attainment and sustainability of patient-centered medical homes. EOHHS and OHIC have a long history of collaborating to transform RI’s health care delivery system to focus on value and improve quality. The State understands that alignment across markets and providers promotes quality, efficiency, and improved patient outcomes. RI has included non-binding letters of intent from two community hospitals and two commercial insurers in its application – plus letters of support from primary care providers. Together, the State and its health care partners are excited about this Cooperative Agreement opportunity and are look forward to working with CMMI to improve RI’s healthcare system.
