Grants & Scholarships

Coordination to improve health outcomes

The patient-centered medical home (PCMH) model is a true demonstration of innovation, leadership, and impact in the health care realm.

Improved care, lowered costs, and better health outcomes for Rhode Islanders. These are the admirable goals of the patient-centered medical home model. This approach to care employs a health care team, led by their doctors, to assure that all the pieces are in place to keep patients healthy.

The Care Transformation Collaborative (CTC) was co-convened in 2008 by the Office of the Health Insurance Commissioner and the Executive Office of Health and Human Services to promote care through the patient-centered medical home (PCMH) model.

“The CTC looks at how care is delivered in Rhode Island, mostly at the primary care level and is very engaged in trying to improve outcomes for patients and for providers,” states Marie Ganim, PhD., co-chair of CTC.

CTC has worked with 109 practices and more than 750 primary care providers who provide care to more than 650,000 Rhode Islanders.

“The work that CTC has done has led to a pretty dramatic change in how our practice functions."

- Thomas Bledsoe, MD

“The work that CTC has done has led to a pretty dramatic change in how our practice functions. It has built a community of collaborators and also a team within my office to take care of my patients,” explains Thomas Bledsoe, MD, president of the CTC board of directors, noting that the team includes a social worker, nurse care manager, psychologist, and pharmacist. “I think both the physicians who work in this environment and the patients are really starting to experience the transformation and like what they see.”

In a study conducted in 2017, CTC found that that total cost of care spending in 2016 for patients at CTC practices was $217 million less than equivalent care at non-PCMH practices. Understanding the drivers and monitoring the trend of health care costs are important first steps towards controlling health care spending.

The PCMH model promotes prevention and wellness, and offers greater access to the primary care team for coordinated treatment. Through the Foundation’s investments and the continued transformation of primary care, we hope to see progress toward our 2025 impact targets of 90% of adults having a routine annual checkup and 75% of children having a medical home.

The PCMH model is a true demonstration of innovation, leadership, and impact in the health care realm. These are the qualities that earned the Care Transformation Collaborative our Community Leadership Award in 2018.