Care Coordination Initiatives

Current Projects

CareConcepts: Integrating Payor Sponsored Disease Management Into Primary Care Practice

In December 2005, CCPC received funding from the Physician Foundation for Health Systems Excellence to implement CareConcepts. The goals of CareConcepts are to improve the process of chronic illness care within primary care practices and to improve clinical outcomes for chronic disease patients. Specific objectives include:

To identify barriers to the incorporation of disease management (payer sponsored) into routine primary care practice patient care;
To enhance the communication between payer, disease management entities, and primary care physicians;
To streamline multiple different types of disease management communications coming from each managed care payer for each specific disease into patient centric chronic care disease management CareConcepts;
To pilot test the efficacy of a CareConcepts two-way structured communications between primary care practices and disease management entities;
To enhance physicians’ capability of formulating a quick assessment and identification of next steps and responsibilities in managing chronic disease patients; and
To integrate disease management into primary care practice.

Connecticut Health Information Security & Privacy Initiative (CT-HISPI) - Phase III

Established in June 2006 by Research Triangle Institute (RTI) international through a contract with the U.S. Department of Health and Human Services (HHS), the Health Information Security and Privacy Collaboration (HISPC) was charged to access the current environment of health information exchange and plan ahead for future. Connecticut was one of the 34 states and territories. CCPC (ProHealth) in collaboration with Connecticut Public Health Foundation has taken a lead in managing this project.

In the first phase of the project, the teams defined the following processes:

Access variations in organization–level business policies, state laws and barriers that affect health information exchange (HIE).
Identify and propose practical solutions while preserving the privacy and security requirements.
Develop detailed plans to implement solutions.

The current phase which began in April of 2008 comprises 42 states in 7 multi state collaborative privacy and security projects focused on:

Analyzing consent data elements in state law
Studying intrastate and interstate consent policies
Developing tools to help harmonize state privacy law
Developing tools and strategies to educate and engage consumers
Developing a toolkit to educate providers
Recommending basic security policy requirements
Developing inter organizational agreements

Each project is designed to develop common, replicable multi state solutions that have the potential to reduce variation and harmonize privacy and security practices, policies and laws.

Connecticut is currently developing a set of basic security policy requirements for authentication and audit. These requirements consist of:

Policy - set of legal, political, organizational, functional and technical obligations for communication and cooperation
Policy Agreement – written agreement where all involved parties commit themselves to a specified set of policies
Implementation - design an implementation strategy that guides a state’s adoption and use of the NHB (National Health Bridge).
Data Sharing - share information across state lines
Provider Access - focus on provider access to the HIE system

The CCPC/ProHealth Research team will continue to update ProHealth about the CT-HISPC accomplishments.

The ProHealth House Call Program: Is it an effective Patient Care Model?

The Connecticut Center for Primary Care (CCPC) is working with ProHealth Physicians and the University of Connecticut Urban Service Track (UST) to develop an inter-professional training program entitled Home Care for Older Adult Patients. This program will become a training program for all students enrolled in the UST. It brings together private practice with the University of Connecticut’s health professional training schools and the City of Hartford's Health and Human Services Elder Division to provide training/support students committed to providing care to urban underserved patients. The main goals for this program include teaching health professional students the value and practice of health care in a home setting; and, teaching health professional students the fundamentals of research in a clinical environment. CCPC will coordinate the study and survey administration.

Past Projects

CT-HISPI: Connecticut Health Information Security & Privacy Initiative – Phase I

In the first phase of the project, the teams defined the following processes:

Access variations in organization–level business policies, state laws and barriers that affect health information exchange (HIE).
Identify and propose practical solutions while preserving the privacy and security requirements.
Develop detailed plans to implement solutions.

Connecticut Health Information Security & Privacy Initiative (CT-HISPI) - Phase II

The Public Health Foundation of Connecticut, Inc. was designated by the Office of the Governor to apply on behalf of the State for a competitive grant offered by Research Triangle Institute (RTI) to examine health information security and privacy issues. The Foundation sub-contracted much of the project to the Connecticut Center for Primary Care. The first phases of the project, completed in December 2007, focused on assessing the variation in business practices and barriers to legitimate electronic health information exchange, proposing solutions for the significant barriers, and designing a plan for implementation of those solutions. Connecticut’s first implementation step was to “Define the specifications for a health care workforce digital identity management system.” RTI compiled the reports from Connecticut and 33 other states and territories working on the project and submitted the findings to the United States Department of Health and Human Services.

The Connecticut team has been developing a model solution/system design, preparing educational material, vetting the proposed model with the Connecticut Department of Health licensing department and other stakeholders, integrating national standards, and exploring opportunities to integrate the model with other national identify management projects.

For the next round, due to start in April 2008, CCPC will join with 9 other states in a collaborative to develop Basic Policy Requirements for Authentication and Audit in a trusted exchange of health information between entities employing different business models. The intent of the basic policy requirements is. In order to support cross network exchange of health information, this work will examine basic policy requirements including: current states’ system policies; variation across systems; trends in authentication and audit protocols; and, recommendations for policies and processes for approving and implementing those requirements needed to make HIE interoperability a practical reality.

This Collaborative will focus on two of the four privacy and security domains, which are:

Authentication: This policy may include requirements for registration, data-sharing, identity verification, and provision and maintenance; and,
Audit: This policy may include basic requirements for auditing provider-access to the HIE to include required fields and the process by which the HIE audits access.