Care Transformation Collaborative of RI

News & Updates | May 2023

Spotlight: New CTC-RI task force addressing primary care workforce crisis

Rhode Island is currently experiencing a historical shortage of primary care providers, leading to challenging workloads for current teams and obstacles to finding care for patients. To help better understand this urgent issue and identify ways to address this challenge, CTC-RI formed a Task Force for Primary Care Workforce Development to meet regularly and help guide the primary care industry and state forward.

The Task Force convenes leadership from Rhode Island training programs for physicians, nurse practitioners, and physician assistants, and collaborates with primary care experts and with state programs focused on healthcare workforce. Together, the diverse Task Force is developing a strategic plan for recruiting, training, retaining, and sustaining a primary care workforce that will meet the state's population health needs.

CTC-RI Executive Director, Debra Hurwitz, MBA, BSN, RN, highlights the important work of this Task Force, co-chaired by CTC-RI board members Denise Coppa, PhD, APRN-CNP, FAANP, FAAN, Family Nurse Practitioner Track Coordinator and Project Director, Academic-Clinical Partnership at the RI Nursing Education Center, and Jeffrey Borkan, MD, PhD, Assistant Dean of Primary Care-Population Medicine.

What challenges does Rhode Island's primary care industry currently face?

Data show our state is expected to have a deficit of almost 100 Primary Care Providers (PCPs) by 2030. As we emerge from the pandemic, the situation has grown much worse. A number of primary care practices did not survive the pandemic shutdown; primary care providers are retiring early and many more are approaching retirement age; a number of PCPs are leaving to join for-profit entities with significant venture capital funding. In addition, the “great resignation” has made it increasingly difficult for primary care practices to hire nurses, medical assistants, behavioral health clinicians and other key staff, leading to even higher burnout among PCPs. Finally, since 2019 our population has increased by 35,576 residents in need of primary care further exacerbating the situation. Recent articles in the Boston Globe and Providence Journal have reported on the enormous difficulty for people to get an appointment with a primary care doctor. In short, all of these factors and more have created a primary care crisis in Rhode Island gaining national and regional attention. Read more.

How is the Task Force uniquely positioned to evaluate and help address these challenges?

Given the post-pandemic crisis in primary care described above, the CTC-RI Board directed management to convene a Task Force of all the Program Directors of primary care training programs in the state, including physicians, nurse practitioners, and physician assistants. The Primary Care Provider (PCP) Task Force on Workforce Development convened in February 2023. It was the first time ever that the program directors of colleges and universities such as Brown University, University of RI, Salve Regina University, and Johnson and Wales University met to discuss the current state of primary care here, along with their program capacity, challenges, and potential solutions. This represents a unique academic clinical partnership. Read more.

What emerging opportunities, ideas, or issues is the Task Force considering? What lies ahead?

The Task Force members have agreed to continue meeting to develop a statewide strategic plan to increase the number of primary care providers by increasing recruiting, training, retaining and sustaining the primary work force needed to meet the needs of all Rhode Islander’s. In addition, our Task Force submitted a funding request to Senator Whitehouse’s Congressional Direct Spending Committee for FY2024. This proposal addresses the primary care provider workforce shortage that has worsened post-pandemic. Read more.

Behavioral Health Distinction Year 2 Learning Collaborative

CTC-RI hosted the final wrap-up meeting of our NCQA Behavioral Health (BH) Distinction Year 2 Learning Collaborative, made possible through funding from UnitedHealthcare.

The two-year program supported 14 practices, who gathered to share outcomes and progress, and reflect on program elements they found most valuable. Among the program's feedback, our great practice facilitators, Drs. Liz Cantor and Kristin David, were highlighted by some practices:

“I really learned a lot…and it was a great opportunity, under Liz’s great leadership, to get everyone on the same page.” (Hasbro Children’s Hospital, Carol Lewis)

"We can't thank Dr. David enough. You've been so wonderful in helping us advocate, and we're just so grateful for the accomplishments that we've made in these past 2 years. We've had a lot of fun on this project, thanks to Dr. David's encouragement and guidance.” (Family Care Center, Stephanie Czech)

Multiple practices will be applying for NCQA BH Distinction, and Brown Medicine has already received their distinction. Congratulations to our NCQA Year 2 BH Distinction practices!

  • Anchor Medical Lincoln
  • Anchor Medical Warwick
  • Anchor Medical Providence
  • Aquidneck Pediatrics
  • Brown Medicine (received NCQA Distinction)
  • Barrington Pediatric Associates
  • CNEMG Family Care Center
  • Hasbro Children’s Hospital Pediatric Primary Care
  • NRI Pediatrics

Healthy Tomorrows Cohort 3 - Quarterly Learning Collaborative Meeting

In April, the new Healthy Tomorrows cohort met to share information about themselves, their agency or practice, and their goals for the 12-month collaborative. The Healthy Tomorrows learning collaborative, funded by RIDOH and Tufts Health Plan, aims to support primary care practices and family visitors to better facilitate patient and family access to health care and related preventive services, identify and enroll more families in evidence-based family visiting programs, and strengthen and support engagement in primary care and other supports and services. Join us in welcoming our new teams!

  • CNEMG Family Care Center (practice) and Childrens’ Friend Healthy Families America (Familty Visiting)
  • Thundermist West Warwick (practice) and CCAP Healthy Families America (Family Visiting)
  • Dr. Susan Stuart (practice) and Westerly Public Schools Parents as Teachers (Family Visiting)

The meeting presentation can be accessed here and the meeting recording here.

Welcome our new CTC-RI Project Manager!

Meet Yolanda Bowes

Yolanda Bowes has joined CTC-RI as a contract project manager to support several important CTC-RI projects including a new demographic data collection pilot program aimed at identifying and reducing health disparities in underserved communities, a prior authorization project, a cost calculator initiative that will assist providers in the transition to a value-based payment model, and the primary care workforce development task force. Yolanda earned a Bachelor’s in Management from Eastern CT State University, and has a long history managing new and exciting private, state and federally-funded programs to address social determinants of health, as well as practice operations in both a federally qualified health center and a large accountable care organization outpatient clinic. Read more.

Care Coordination ECHO Learning Session beginning this month!

With funding from RIDOH, CTC-RI is launching a new seven-series Care Coordination ECHO®--a virtual learning community offered at no cost. This all-teach, all-learn model includes a brief presentation from a subject matter expert followed by a case study to elicit discussion and recommendations. We will focus on strategies to improve care coordination for families with young adults with special healthcare needs, transitioning from pediatric to adult care. Participants (including pediatric and adult practice team members, community health workers / peer resource staff, school nurses and care coordinators) will collaborate with each other and learn how to better support youth and families. Registration is due May 25! Learn more about the series here. Questions? Contact Kim Nguyen-Leite.

  • May 31 - Family Voice & Entitlement to Eligibility | Tara Hayes and Stephanie Trafka, RIPIN
  • June 29 - Guardianship | Rebecca M. Kislak, MLPB
  • July 26 - Understanding BHDDH/ Developmental Disability Transitions of Care | Susan Hayward and Denise Achin, BHDDH
  • August 30 - Care Coordination for Children with Special Healthcare Needs in College | Adam Pallant, Brown University
  • September 27 - Supporting Youth in Foster Care & DCYF | Lisa Guillette, Foster Forward & Joan Harmon, DCYF
  • October 25 - Durable Medical Equipment & Resources | Carol Musso, UHC
  • November 29 - Autism | Susan Jewel, The Autism Project

Clinical Strategy Meeting focuses on improving health equity while leveraging demographic data

CTC-RI’s April Clinical Strategy Committee meeting focused on improving health equity through demographic data collection. Amelia Bedri, MHSA, NCQA's Senior Content Engineer, Product Management, spoke about the NCQA health equity work with emphasis on NCQA’s health equity accreditation. Natasha Viveiros, MS, Director, Site Operations & Special Projects, and Andrew Saal, MD, MPH, Chief Medical Officer, both of Providence Community Health Centers (PCHC), shared PCHC's efforts to further improve their data collection abilities. These strategies included furthering staff training, enhanced communication among staff and patients, and leveraging the data to better understand their patient population. Jay Buechner, Neighborhood Health Plan of RI (NHPRI) Director of Quality Improvement, spoke to efforts by NHPRI and how they are using race and ethnicity data to address member groups with gaps in care as identified by low Healthcare Effectiveness Data and Information Set (HEDIS) measures. To view the recording, find more resources and claim CME credit, visit our CME Coursework webpage.

Rhode to Equity teams gather to celebrate accomplishments at conference

This month, in partnership with RIDOH and EOHHS, CTC-RI hosted its second Rhode to Equity Conference which brought together more than 80 attendees, including the six Rhode to Equity teams, state partners, managed care organization staff, community health workers and other stakeholders. This conference celebrated two years of work across multi-sector stakeholder teams to advance equity in their communities. Highlights of the day included subject matter expert sessions with local leaders who are on working with people of lived experiences of inequities and leveraging data and evaluation for advocacy. The keynote was provided by Estrus Tucker, DEI Consultants President and CEO who spoke about emotional intelligence as a tool to further equity work. Estrus engaged attendees and spoke about techniques that individuals can use in their work including intentionally listening, suspending judgements, and having cultural humility. Rhode to Equity teams then provided short presentations on their accomplishments throughout the initiative and goals for future work.

In the afternoon, attendees heard from a panel of Managed Care Organization (MCO) representatives from Neighborhood Health Plan, Tufts Health Plan/Point32Health, and UnitedHealthcare. Rhode to Equity teams then had focused conversations with each other and MCO representatives about continued sustainability and advancing their current equity work. Soma Saha, MD, MPH, Well Being & Equity in the World CEO & President, led attendees in a closing reflection before kicking off a CHW-led self-care session. This session was developed and led by Swanette Salazar, the lead CHW on this project.

Estrus Tucker, DEI Consultants President & CEO, speaks to attendees at the Rhode to Equity Conference.

Cynthia Roberts, PhD, (right), RICDAV and Sydney Ormerod (left), Woman's Resource Center, lead a presentation about data and evaluation.

Ambar Delgado, West Elmwood Housing Development Corporation CHW, leads participants through a self-care session.

Spring Team-Based Care meetings address interventions for dementia and behavioral strategies to improve sleep

Our monthly Best Practices in Team-Based Care meeting continues to highlight best practices from across the state. In April, CareLink presented on non-pharmacological interventions for dementia. Robyn Earley, MA, CCC-SLP, CDP, CMDCP and Kelley Hurley, BS, PTA of CareLink covered a variety of non-pharmacological treatment options for dementia, underlining repeatedly their central message: dementia is treatable. In particular, the presentation highlighted the Alzheimer’s Disease Program Initiative Grant, and CareLink’s Skills2Care program, an evidence-based program for individuals with mild to moderate Alzheimer’s Disease and Related Dementias (ADRD). Through cognitive stimulation therapy, caregiver education, and environmental strategies, the program seeks to improve the quality of life for individuals living with ADRD and their families. The presentation concluded with referral information and several inspiring case studies. Resources from April's Non-pharmacological Interventions for Dementia Presentation: Recording and PPT. Flyers and resources for CareLink and Skills2Care: Rack Card and One Pager. Application for CME credit for this program has been filed with the American Academy of Family Physicians. Determination of credit is pending.

In March, our Best Practices in Team-Based Care group was invited to join URI’s Geriatric Education Center for a program on Aging and Sleep. Attendees were able to learn about the impact of aging on sleep and basic behavioral strategies to improve sleep. The recording and materials from this session, as well as CEU information, can be found on the Geriatric Education Center website.

Join us for Breakfast of Champions on June 9

CTC-RI will host its quarterly Breakfast of Champions Meeting on June 9 at 7:30am. Stephen Moberg, Executive VP & COO, Team Care Medicine, and Dr. Arnold Goldberg, Thundermist will present their progress with developing care teams using medical assistants (MA) as scribes.

Team Care Medicine helps many doctors around the country struggling with reducing physician burnout and improving well-being. The Team Care Medicine model leverages a real-world solution developed by 30-year primary care physician Dr. Peter Anderson, which makes doctors 20-40% more productive while reducing their after-hours work. This is accomplished by the addition of one clinical assistant (a team care assistant/MA) to their team, allowing the provider to get off the EHR.

Dr. Arnold Goldberg, Associate Program Director at the Warwick site, joined THC in August 2016 as a family medicine physician. With more than 30 years in medicine, he was Lehigh Valley Family Health Center (LVHC) Professor of Family Medicine and Medical Director. Prior time spent at LVHC, Dr. Goldberg was Pawtucket Memorial Hospital Medical Director and Clinical Team Leader of the Family Care Center. Dr. Goldberg’s specialty areas include diabetes care, group medical visits, behavioral medicine, geriatrics, Suboxone care and Balint Groups. In addition, Dr. Goldberg is the Brown Family Medicine Residency Program Associate Program Director at Kent Hospital/Warwick based out of Thundermist Health Center.


CTC-RI announces first keynote speaker for October 5, 2023 conference!

CTC-RI is excited to announce our first keynote speaker will be Susan J. Kressly, MD, board-certified Pediatrician and Clinical Informaticist. Dr. Kressly has over 30 years of clinical experience in pediatric practice, almost two decades of business experience as the founding partner of innovative Kressly Pediatrics, and over 15 years in Pediatric Health IT championing the pediatric voice at the Health IT table. Dr. Kressly has served multiple volunteer leadership roles at the American Academy of Pediatrics. She is currently Chair of the Payer Advocacy Advisory Committee, and is involved in the Council on Clinical IT, the Section on Telehealth Care, the Section on Administration & Practice Management, the Council on Clinical Quality Improvement, the Child Health Informatics Project Advisory Committee and others. She is the former President of the PA Chapter of the American Academy of Pediatrics.

Dr. Kressly received her medical degree from Temple University School of Medicine and served her residency at St. Christopher’s Hospital for Children. Dr. Kressly began practicing in the Doylestown area in 1990 and has been an involved member of the medical community since then. Her independent pediatric practice has been a recognized medical home since 2011.

In addition, she adds her pediatric expertise and advocacy voice to national health IT conversations including HIMSS, ONC workgroups, EHRA and others. Dr. Kressly’s “North Star” is ensuring that every child has the best chance at a bright future, and supporting the pediatric clinicians who are essential to success.

Missed CTC-RI meeting or learning session? Catch up here!

CTC-RI offers CME credits for select meetings, including asynchronous viewing of meeting recordings. Learn more and access evaluation forms here.

  • Medicaid Pediatric Healthcare Recovery Program Behavioral Health ECHO® Learning Session - CBT/Anxiety | April 2023 (presentation and recording)

  • ECHO® Learning Series - Age-Friendly Approaches to Dementia Care: Safety Concerns When Caring for Someone with Dementia* | April 2023 (evaluation)

  • ECHO® Learning Series - Age-Friendly Approaches to Dementia Care: Understanding and Responding to Dementia Related Behaviors* | May 2023 (evaluation)

Practice Resources, News, and Information

Health Affairs: Integrating Behavioral Health in Primary Care: Overcoming Decades Of Challenges

CTC-RI's work was highlighted in a new Health Affairs article spotlighting the national mental health crisis. According to a poll last summer conducted by CNN in partnership with the Henry J. Kaiser Family Foundation, 9 out of 10 adults in the US believe that the country is facing a mental health crisis.

Certification opportunity: Chronic Pain Self-Management

The Own Your Health Collaborative is looking for individuals interested in becoming certified leaders of the Chronic Pain Self-Management program. Individuals who wish to become Chronic Pain Self-Management Program leaders must complete a four-day leader training hosted at RIPIN in Warick on June 20, 23, 28, and 30th. If you are interested please contact Jasmine Franco at

Attention Healthcare Grads: RI's Wavemaker tax credit program could benefit you!

The Wavemaker Fellowship program provides a refundable tax credit to professionals working at employers throughout Rhode Island. Learn more.

MLPB April Update: The End of the Public Health Emergency, and More!

Access news and resources from MLPB's newsletter here.

Upcoming CTC-RI Committee Meetings and Workgroups

  • June 08, 07:30-09:00AM – Prior Authorization Kickoff Meeting
  • June 14, 08:00-09:00AM – Task Force for Primary Care Provider Workforce Development
  • June 16, 07:30-09:00AM – Clinical Strategy Committee

Upcoming Learning Collaboratives and Professional Development

  • May 24, 07:30-08:30AM – Medicaid Recovery Program BH ECHO Learning Session - Medication Management in Pediatrics
  • May 25, 07:30-08:30AM – ECHO® Learning Series - Approaches to Dementia Care: Building Blocks for Becoming Age-Friendly
  • May 31, 07:30-09:00AM – Care Coordination ECHO® Session #1
  • June 01, 07:30-08:00AM – Virtual Coffee Breaks with Dr Pat Flanagan & Dr Beth Lange
  • June 08, 07:30-08:30AM – ECHO® Learning Series - Approaches to Dementia Care: Building Blocks for Becoming Age-Friendly
  • June 09, 07:30-09:00AM – Breakfast of Champions
  • June 15, 07:30-08:30AM – Pediatric Weight Management ECHO® Session
  • June 16, 12:00-01:00PM – Integrated Behavioral Health Meet and Eat
  • June 20, 08:00-09:00AM – Best Practices in Team-Based Care (formerly NCM/CC Best Practice Sharing)
  • June 21, 08:00-09:30AM – Care + Community + Equity Best Practice Sharing
  • June 22, 07:30-08:30AM – Medicaid Recovery Program BH ECHO Learning Session - Suicide Risk, Prevention & Tools
  • June 29, 07:30-09:00AM – Care Coordination ECHO® Session #2
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