Name of Practice: Connect CARRE Program (RI0601) Abstract: The State of Rhode Island seeks to control program costs and improve the quality of care for disabled and elderly adults in its fee-for-service Medicaid program through the Connect CARRE Program. The Program assures that each participant has a medical home, a plan of care that responds to the individual's unique service needs, the skills necessary to manage and monitor chronic conditions, and the ability to recognize situations that require medical intervention. Utilization data and performance measures indicate that the program has reduced unnecessary hospitalizations, improved access to providers, services and care in the community; and enhanced the quality of life for participants. The Problem The Connect CARRE Program was developed in response to concerns about the cost and quality of care for disabled and elderly adults in Rhode Island's fee-for-service Medicaid program. Costs for this population increased 18 percent between 2000 and 2002, with the largest increase in institutional care. The State of Rhode Island attributed this growth in expenditures to the lack of a medical home for many of these individuals, an inability to access appropriate care, poor interagency communication, and a high ratio of patients to nurse case managers. Discussion of Approach Administered by the Center for Adult Health of the Rhode Island Department of Human Services, the Connect CARRE Program is a voluntary, comprehensive care management and wellness program implemented in 2002 under Medicaid state plan authority to serve frail elderly and disabled consumers in a fee-for-service environment.The goals for the Connect CARRE Program are to improve wellness by empowering chronically ill consumers to manage and advocate for their own services, to shift care from institutional to community and ambulatory settings, to increase access to behavioral health services, and to improve disease specific medication compliance. The target population includes a culturally diverse and economically disadvantaged group of disabled and chronically ill Medicaid members age 22 and older with Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), Sickle Cell Anemia, asthma, diabetes, and depression. The target population also includes Medicaid members who are frequent users of acute care services, who reside in a community setting but lack social and community supports, or who are at risk for recurrent adverse medical events, frequent hospitalizations, and emergency room visits. The State actively recruits patients into Connect CARRE through referrals from discharge planners, home health workers, and physicians' offices. Other consumer recruitment strategies include notifying individuals who meet program enrollment criteria that they are being enrolled with an option to disenroll and placing a bilingual onsite nurse case manager at Rhode Island Hospital to engage prospective enrollees and discharge planners in recruitment efforts. Recruitment information is disseminated in six languages. Potential enrollees are screened based on a review of the individual's claims history, self-reported physical and mental health status, and standardized metrics. Connect CARRE ensures each member has a medical home and brings together the member and his/her family, the lead physician, and a nurse case manager to address the member's needs. Coordination of care is provided primarily by State Medicaid agency personnel, with additional case management support furnished under the State Plan through a contract with Neighborhood Health Plan of Rhode Island. This team works together to develop and implement a plan of care that can also include social supports and services. The team seeks to motivate the enrollee to recognize signs and symptoms that require clinical intervention and provides the enrollee with a consumer notebook that includes resource contacts. The State has encountered several challenges in implementing the Connect CARRE Program. They include creating a predictive modeling search capacity that can identify Medicaid recipients who meet the target criteria, recruiting physicians to participate in the program, recruiting individual consumers into this voluntary program with the minimal staff and resources available to the State, and retaining individual enrollees for the minimum six-month period required for inclusion in performance measures. Physician recruiting strategies include additional payment for care planning conferences, support for managing difficult and time consuming patients, and facilitating communication with other providers. The Rhode Island Department of Human Services collects outcome measures for participants in this program to document: - Decrease in adverse medical events for program members - Improved health and functional status of program members - Disease-specific clinical outcomes - Reduction in inappropriate hospitalizations - Improved compliance with medical appointments - Improved appropriate medication compliance - Flu/pneumonia immunization rates - Smoking cessation - Consumer satisfaction - Physician satisfaction Results and Future Plans As of December 2006, the program had served 230 active enrollees for a minimum of 6 months and a cumulative total of 610 enrollees over a period of 4 years. The program has reduced unnecessary hospitalizations; improved access to providers, services and care in the community; and enhanced the quality of life for participants. The State has worked to continually refine the Connect CARRE Program. Outreach for behavioral health services has improved through a dedicated approach to improved communication and referral process. The Program has also benefited from the State's participation in the Agency for Healthcare Research and Quality's Medicaid Care Management Learning Group- Knowledge Transfer. For calendar year 2003, acute hospitalization cost $1,000,000 less for a subgroup of 45 Connect CARRE enrollees than a control group of 45 recipients who were eligible but refused enrollment. The 2003 per member per month (PMPM) cost for Connect CARRE enrollees was 32 percent lower for the experimental group than the control group (i.e., $3,395 for enrollees versus $4,995 for non-enrollees). Claims data for 2004 indicate that enrollee utilization of home and community based, behavioral health services, and prescribed drugs have increased compared to a control group of non-enrollees. Preliminary results from a Connect CARRE enrollee satisfaction survey are very positive with regard to self-management and improvements in quality of life. Disease-specific measures for diabetes, congestive heart failure, sickle cell anemia, chronic obstructive lung disease, and depression for 2003 are encouraging and will serve as a quality improvement focus. Enrollment in the Connect CARRE Program is expected to increase with the State's plans to incorporate it into a new Primary Care Case Management Program, Connect Care Choice. The State also plans to offer Connect CARRE enrollees workshops in application of the Stanford University Chronic Disease Self Management Model during 2007. Further Information Contact: Ellen Mauro, RN. MPH
Chief, Family Health Systems
Center for Adult Health
Department of Human Services
600 New London Avenue
Cranston, RI 02920
Tel: (401) 462-6311
FAX: (401) 462-6339
e-mail: emauro@dhs.ri.gov This Profile has been posted to the CMS Medicaid/CHIP Quality website for informational purposes only and does not convey CMS endorsement of the practice itself. The descriptive information supplied and the results reported in this Profile have been supplied by sources familiar with the practice but have not been independently validated by CMS.
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