Delivery System and Payment Reform

The Institute for Health Policy and Practice's efforts in the area of Delivery System and Payment Reform drives healthcare systems change to improve healthcare quality and support value-based payment.

For more information, contact Jeanne Ryer at Jeanne.Ryer@unh.edu.


NH Citizens Health Initiative Annual Symposium

September 29, 2020

The NH Citizens Health Initiative annual Symposium  provided insights on the latest national health policy topics, and attendees discussed how to improve health care systems in New Hampshire. Read more

Projects and Initiatives

NH Citizens Health Initiative logo

The NH Citizens Health Initiative is a multi-stakeholder effort working to develop a healthy population and high-quality, cost-effective and accessible healthcare system for our state.

NH CHI provides leadership, convening, project management, and research support across the Pillar projects including:

  • New Hampshire Accountable Care Project: Transforming Systems through Shared Data and Learning
  • Health Promotion/Disease Prevention
  • Public Health and Clinical Integration Project through Tobacco Mitigation
  • MapNH Health Project

ANEW LOGO

ADVANCED NURSING EDUCATION WORKFORCE (ANEW)

The UNH Advanced Nursing Education Workforce (ANEW) program funds Primary Care Family Nurse Practitioner (NP) students with trainee-ship awards to students who work and train in rural and under-served settings. ANEW provides NP students with the practice, preceptor, and peer support they need to address current workforce challenges in these unique primary care environments. ANEW also provides support and professional development opportunities for preceptors working alongside ANEW trainee-ship students.

ANEW professional development focuses on the key, high priority health concerns of rural New Hampshire, including behavioral health, substance use disorder, and telehealth providing continuing education for both the preceptor and NP preceptee using an all-teach all-learn continuing education strategy

This grant is supported by the Advanced Nursing Education and Workforce Initiative, Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2.8 million dollars with percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

UNH is a Project ECHO Hub participant and has created the Partnership for Academic-Clinical Telepractice (PACT), which is led by the UNH Institute for Health Policy and Practice, NH Citizens Health Initiative. 

Learn More

UVM CORA

UVM CORA

The University of Vermont Center on Rural Addiction (UVM CORA) is supported by the Health Resources Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), and was established in the fall of 2019. Our mission is to expand addiction treatment capacity in rural communities by providing consultation, resources, training, and evidence-based technical assistance to healthcare providers and other staff. At UVM CORA, we want to leverage our expertise in evidence-based practices for treating Opioid Use Disorder (OUD) and other Substance Use Disorders (SUDs) to: 

  • Identify real-time needs of rural communities and science-supported methods for effectively addressing current and future addiction needs. 

  • Deliver ongoing technical assistance and workforce training to support the effective use of best practices for assessing and treating rural patients. 

  • Disseminate education and resources on evidence-based treatment and prevention to rural providers and policymakers. 

Our priority areas cover the HRSA-designated rural counties in VT, NH, ME, and northern NY, but our Center is designed to provide services nationally. 

NH Pediatric Improvment Partnership logo

NH Pediatric Improvement Partnership

Started in 2013, the New Hampshire Pediatric Improvement Partnership (NHPIP) is a program of the NH Citizens Health Initiative, coordinated by the Institute for Health Policy and Practice at UNH, with Medical Director leadership from the Children's Hospital at Dartmouth (see graphic below). The NHPIP is a state-level multi-disciplinary collaborative of private and public partners dedicated to improving health care quality for all NH children through the use of systems and measurement-based quality improvement processes. We do this through:

  • Promoting awareness of and interest in pediatric care quality measurement, projects, and resources
  • Facilitating dialogue to identify and act upon pediatric care quality opportunities in NH.
  • Conducting and/or collaborating on pediatric quality improvement projects

NH Mental Health Access in Pediatrics (NH MCAP)

NH MCAP

In collaboration with the NH Maternal Child Health Bureau, the NH Pediatric Improvement Partnership is conducting the NH Mental Health Access In Pediatrics (NH MCAP) Project. Funded by a multi-year Health Resources and Services Administration Cooperative Agreement, the goal of NH MCAP is to promote behavioral health integration in pediatric primary care by:1) training and supporting NH's health care providers to identify and care for children with pediatric mental health conditions; 2) enabling front-line health providers to receive provider teleconsultation services about the identification and treatment of children with a mental health condition; 3) enhancing the delivery of services through the creation of a referral directory of pediatric mental/behavioral health services and supports.

TRAUMA-INFORMED CARE IN PEDIATRICS

trauma informed care in pediatrics

Funded by the NH Children’s Health Foundation,  the NH Trauma-informed Care in Pediatrics Project is a 2.5 year project focused on increasing the capacity of NH pediatric primary care clinicians in screening for and responding to adverse childhood experiences (ACEs). ACEs are potentially traumatic events that occur during childhood such as physical emotional abuse, neglect, caregiver mental illness, and household violence. The goals of this NH Pediatric Improvement Partnership (NHPIP) project are to:

1) increase pediatric general practitioner knowledge about trauma-informed care and existing tools to support addressing trauma in primary care settings and

2) support five pediatric primary care clinics in using quality improvement principles to pilot process(es) to detect and respond to patients experiencing toxic stress. This project will conclude in January 2022.

UNH Project ECHO logo

PARTNERSHIP FOR ACADEMIC CLINICAL TELEPRACTICE - MEDICATIONS FOR ADDICTION TREATMENT (PACT-MAT)

UNH's NH Citizens Health Initiative and the Department of Nursing partnered to develop the Partnership for Academic Clinical Telepractice Medications for Addiction Treatment (PACT-MAT) and launched in 2019. Participants include practice teams (e.g., from hospitals, correctional facilities, rural health centers, and federally qualified health centers, etc.) and student nurse practitioners medications for opiate use disorder (MOUD). The goals of this ECHO are to increase knowledge and confidence in prescribing MOUD, create connection and dialogue with community organizations across the state, raise awareness of harm reduction, stigma, and bias, and to increase access to medications for MOUD.

This was the first ECHO program developed at UNH CHI, and the first in the world to incorporate family nurse practitioner students as well as integrate the ECHO into Nursing curriculum at the UNH Department of Nursing. Funding for this program is provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) grant.

COLLABORATIVE FOR ADVANCING RURAL EXCELLENCE AND EQUITY (CARE2)

CARE2

The University of New Hampshire Institute for Health Policy and Practice (IHPP) and Medical Care Development (MCD)’s Northeast Telehealth Resource Center Program (NETRC) are collaborating on a new virtual learning community for health care providers in rural and underserved communities in northern New England and northern New York thanks to federal investments of $475,000 annually over five years provided by the Health Resources and Services Administration (HRSA), one of only 9 awards across the country. Scheduled to launch on September 30th, 2021, the Collaborative for Advancing Rural Excellence and Equity (CARE2) will respond to the impacts of COVID-19 on our rural communities focusing on residents’ physical and mental well-being. The project will review effects of emerging COVID-19 variants and impacts of isolation and lack of access to treatment for those with substance use disorder and in home and facility-based long-term care. The CARE2 team will provide training through Project ECHO® programs, as well as training resources through an open-access, e-learning portal.

UNH Project ECHO logo

PRECEPTOR ECHO TO ENHANCE ROTATIONS (PEER)

The Preceptor ECHO to Enhance Rotations (PEER) project promotes case-based shared learning across clinical preceptor sites throughout New England and beyond, developing a learning community of preceptors and practice sites while sharing and developing competencies for rural and under-served preceptor sites.

PEER faculty and participants work collaboratively to:

  • Expand the primary care workforce pipeline for rural and underserved populations  

  • Enhance preceptor knowledge and confidence by sharing best practices and case studies combined with shared discussions, recommendations, and resources 

  • Provide tools and shared experiences/innovations for practice efficiency while precepting students 

  • Boost professional connections and create a supportive community among preceptors in New England and beyond 

Resources and Publications

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Chronic Pain Self-Management Project ECHO Series: Evaluation Highlights
August 2022
The Chronic Pain Self-Management ECHO was formed to provide educational content and a networking opportunity for those in rural New Hampshire and New England who work with individuals with chronic pain. This opportunity was in collaboration with the NH Citizens Health Initiative at the UNH Institute for Health Policy and Practice and the UNH Extension team. Six sessions were offered from September 2021 to March 2022. This evaluation report highlights the program background, participation in the series, impact of the series on participants, and considers future opportunities for education, research, and training on the topic of chronic pain self-management. Additional findings will be forthcoming.

Read the Report

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New Hampshire Children and Teens Experiencing Mental Health Disorders: An Analysis of 2019 Healthcare Claims Data
April 2022
The NH Mental Health Care Access in Pediatrics (MCAP) program is a collaborative effort of the NH Department of Health and Human Services and the NH Pediatric Improvement Partnership housed at the UNH Institute for Health Policy and Practice. Funded by the Health Resources and Services Administration, the focus of MCAP is to promote behavioral health integration in pediatric primary care. MCAP provides 1) training to pediatric and family practice clinicians in assessing and treating common pediatric mental health conditions through an annual Project ECHO® learning series, 2) clinician-to-clinician teleconsultation services, and 3) an annually updated referral directory of pediatric mental/behavioral health services in New Hampshire. To inform its programming, MCAP funded this analysis of 2019 pediatric medical and pharmacy claims data from commercial and NH Medicaid payers. Specifically, MCAP sought to examine health care claims for NH’s pediatric population to provide a descriptive analysis of:

  1. The burden of pediatric mental health conditions as defined by the percentage of children under age 18 with mental health conditions,
  2. Mental health conditions and comorbidities with other mental health conditions, and
  3. Mental health medical and pharmaceutical service utilization to produce measures of treatment.

read the report

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Facilitating a Quality Improvement Approach to Childhood Adversity Screening in Primary Care: A Handbook
April 2022
The purpose of this handbook is to guide pediatric and family practice primary care clinics and/or quality improvement (QI) organizations to initiate a process to screen for and respond to Adverse Childhood Experiences (ACEs). This handbook is based on the experience of the New Hampshire Pediatric Improvement Partnership (NH PIP) in supporting five New Hampshire pediatric practices in developing and piloting workflows to address ACEs within their patient population. The handbook provides a short background on project need, followed by a description of the initial implementation plan and required modifications due to varied factors. Next, this handbook outlines the results and lessons learned from of the project’s process evaluation. Finally, the handbook concludes with an improved and updated description of this QI process for replication elsewhere.

Facilitating a Quality Improvement Approach to Childhood Adversity Screening in Primary Care: A Handbook, owned by the University of New Hampshire and authored by Felicity Bernard, Corina Chao, Holly Tutko, and Dee Watts, licensed under CC BY NC ND 2.0.
Read the Handbook

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A Guide to Trauma Informed Pediatric Primary Care
April 2022
The purpose of this document is to serve as a practical guide to implementing trauma-informed care practices in Pediatric primary care clinics. It is designed to provide structure to the processes that are recommended to successfully, detect, treat and provide referrals to families who have experienced trauma and to build capacity and competence for a busy primary care office.

A Guide to Trauma-Informed Pediatric Primary Care, owned by the University of New Hampshire and authored by Felicity Bernard, Corina Chao, Holly Tutko, and Dee Watts, licensed under CC BY NC ND 2.0.

Read the Guide

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UVM CORA NH BNA Full Report
February 2022

The mission of the University of Vermont Center on Rural Addiction (UVM CORA) is to expand addiction treatment capacity in rural counties by providing consultation, resources, training, and evidence-based technical assistance to healthcare practitioners and other staff. With the baseline needs assessment, UVM CORA aims to identify current and future addiction treatment needs and barriers in New Hampshire with direct input from practitioners, policymakers, and other stakeholders.
read the report

screenshot of the UVM CORA NH BNA COVID-19 Impact brief

 

 

UVM CORA NH BNA COVID-19 Impact on Substance Use and Treatment Data Brief
August 2021
This data brief focuses on practitioner and stakeholder baseline needs assessment survey responses related to the impacts of COVID-19 on substance use and treatment in New Hampshire.
read the brief

Quickstart Guide to Teleprecepting: An Interdisciplinary Guide for Conducting Successful Teleprecepting Patient Visits

 

Quickstart Guide to Teleprecepting: An Interdisciplinary Guide for Conducting Successful Teleprecepting Patient Visits
October 2020
Teleprecepting grants us the opportunity to continue to lead the next generation of providers in caring for patients across the care continuum. Regardless of whether telehealth is being used as an emergency stopgap or will become a tool for ongoing practice, we must not delay in leading the next generation of providers and incorporating students into the care continuum. 
read the report
Planning for Project ECHO in New Hampshire

 

Planning for Project ECHO in New Hampshire 
March 2020
Project Extension for Community Healthcare Outcomes (ECHO)is an evidence-based method using web-based teleconferencing to link specialist teams with community-based sites to help community providers improve their ability to manage complex conditions. It has been proven to improve health care outcomes for vulnerable populations with limited access to care because of socioeconomic factors or geography. The New Hampshire Project ECHO Planning for Implementation and Business Sustainability Project undertook a planning process to inform how to best develop Project ECHO at UNH to serve New Hampshire health and community care providers and ultimately improve access to effective, timely care. Also included is a business and sustainability plan for long-term success of the UNH Project ECHO Hub and an evaluation plan for measuring efficacy.
read the report
10 Steps for Improving Diabetes Care in New Hampshire: A Practical Guide for Clinicians and Community Partners

 

10 Steps for Improving Diabetes Care in New Hampshire: A Practical Guide for Clinicians and Community Partners
March 2020 
In 10 Steps for Improving Diabetes Care in New Hampshire you will find an easy-to-follow stepwise format of practical, best-practice strategies that are feasible to implement in any primary care setting. These Strategies are applicable to planning for prediabetes, as well.
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Addressing Childhood Adversity and Social Determinants in Pediatric Primary Care: Recommendations for New Hampshire

 

Addressing Childhood Adversity and Social Determinants in Pediatric Primary Care: Recommendations for NH
July 2020 
The Endowment for Health and SPARK NH funded the NH Pediatric Improvement Partnership to develop a set of recommendations to address identifying and responding to Adverse Childhood Experiences and Social Determinants of Health in NH primary care settings caring for children. Methods included conducting a review of literature and Key Informant Interviews. Themes from these were identified and the findings are summarized in this report.
read the report
Attention Deficit Hyperactivity Disorder (ADHD): Survey Report

 

Attention Deficit Hyperactivity Disorder (ADHD): Survey Report
December 2017
In the spring of 2016, the New Hampshire Pediatric Improvement Partnership conducted an online survey of NH pediatric and family practice clinicians to understand practice patterns, comfort level, and support needs relative to caring for pediatric patients with ADHD. Of the clinicians surveyed, 138 responded yielding a 13% response rate.
read the report
Telehealth and Mobile Health Applied to Integrated Behavioral Care: Opportunities for Progress in New Hampshire

 

Telehealth and Mobile Health Applied to Integrated Behavioral Care: Opportunities for Progress in New Hampshire Report
May 2017
This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizen's Health Initiative. As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health have the opportunity to help achieve this while delivering a robust, empowered patient experience. Combining technology-savvy consumers with New Hampshire's high rate of electronic health record technology adoption, a fairly robust telecommunications infrastructure, and a predominantly rural setting, there is strong foundation for telehealth and mobile health expansion in New Hampshire's integrated health continuum.
read the report
Integrating Behavioral Health and Primary Care in New Hampshire

 

NH Citizens Health Initiative Whitepaper Integrating Behavioral Health & Primary Care in NH: A Path Forward to Sustainable Practice & Payment Transformation
December 2016
In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative created the NH Behavioral Helath Integration Learning Collaborative, as part of its Accountable Care Learning Network (NHACLN). The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service revenues. As well, follow up work on prior developments of a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings.
read the report
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Key Regulatory Issues Facing APCD States Post Gobeille v. Liberty Mutual
2016
The All Payer Claims Database (APCD) Council has collected and compiled responses to key questions posed to regulators in APCD states since the March 1, 2016 decision by the Supreme Court of the United States (SCOTUS) in Gobeille v. Liberty Mutual, related to key regulatory enforcement issues to be considered by states.
READ THE REPORT

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New York's All-Payer Database: A New Lens for Consumer Transparency
September 2015
This report was created by the APCD Council with assistance and support from the New York State Health Foundation (NYSHealth). The authors of this report would like to thank NYSHealth for its funding and content support. Thanks also are extended to the New York State Department of Health for its input, content, and organizational support during this project. Finally, we would like to thank the many New York stakeholders and the interviewees from states other than New York whose thoughtful comments created the backbone for this report.
Support for this work was provided by NYSHealth. The mission of NYSHealth is to expand health insurance coverage, increase access to high-quality health care services, and improve public and community health. The views presented here are those of the authors and not necessarily those of the New York State Health Foundation or its directors, officers, and staff.
READ THE REPORT
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Recommendations for Collecting Payer Information on Plan Benefit Design and Payments to Providers for Non-Claims based Services
September 2014
The primary task for this report is to summarize the work to develop a set of recommendations about the type of information that can be included in supplemental data submissions from the health insurance payers for inclusion in the MCDB, beginning with collection of 2014 data in 2015, and a mechanism for that collection process.
READ THE REPORT
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The Value of All-Payer Claims Database to States
May 2014

All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs.
READ THE ARTICLE

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The Basics of All-Payer Claims Databases: A Primer for States
January 2014
Over the past 10 years, a growing number of states have established state-sponsored all-payer claims database (APCD) systems to fill critical information gaps for state agencies, to support health care and payment reform initiatives, and to address the need for transparency in health care at the state-level to support consumer, purchaser, and state agency reform efforts. States with APCDs are responding to a need for comprehensive, multipayer data that allows states and other stakeholders to understand the cost, quality, and utilization of health care for their citizens. The purpose of this paper is to assist states embarking on APCD initiatives by highlighting key considerations for building statewide APCDs and potential solutions based on experiences in early-adopting APCD states.
READ THE REPORT
Medical Home Evaluation

 

Medical Home Evaluation
November 2013
This study explored the specific nature of the Patient-Centered Medical Home models implemented across the nine pilot sites as well as the process of change enacted at these sites. The nine practices participating in the pilot varied with respect to their size, ownership, and history. The pilot sites are located across the state of New Hampshire, and vary in terms of the number of providers and the patient population served.
read the report
NH Public TV Special -NH Health Care: Is There Good News?

 

NH Public TV Special- NH Health Care: Is There Good News? 
February 2012
A look at what's being done in the Granite State to reduce health care costs while improving care for patients. Focused is the Medical Home Project initiative.
watch the video
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APCD Cost Study Summary of Findings
2012
This report presents a summary of the costs to states associated with the development of AllPayer Claims Databases (APCDs). The findings are based on information gathered from states that have implemented APCDs, including review of state vendor contract documents and telephone interviews with state contacts. Both current and expired contract documents were reviewed.
READ THE REPORT

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History of APCD Council Harmonization Efforts
October 2011
In 2008, the emergence of All Payer Claims Databases (APCD) was not only promising in terms of the potential of APCDs to explain and bend the cost curve of rising health care costs, but also presented a potential problem if each of the 50 states did not require the use of national standards for collecting the data from the payers. The APCD Council was formed to respond to this problem. With a learning network of states, insurers, vendors, and other stakeholders who are advancing the knowledge and development of All-Payer Claims Databases (APCD)1 , the APCD Council has been involved in the advocacy for and development of standards for APCD data collection for three years. Our work has been supported to date by The Commonwealth Fund, Academy Health’s State Coverage Initiative, Agency for Healthcare Research and Quality, National Governor’s Association, and with direct funding from UNH and NAHDO.
READ THE REPORT
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Fact Sheet: APCD and Health Reform
June 2011
This fact sheet focuses on the potential contributions of APCDs to health reform. Given the breadth of health reform, and the multiple possible uses of APCD data, this fact sheet is not intended to be a comprehensive review, but should serve to highlight some key opportunities available to states that have APCDs.
READ THE FACT SHEET
NH Patient-Centered Medical Home Pilot Documentaries NH Patient-Centered Medical Home Pilot Documentaries
February 2011
In 2008, The New Hampshire Citizens Health Initiative, in partnership with groups from all parts of the New Hampshire healthcare system, launched the Multi-Stakeholder Medical Home Pilot. Video series on the nine pilot sites throughout the state that are participating in the 2-3 year study of PCMH.
watch the series
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Standardization of Data Collection in All-Payer Claims Databases
January 2011
READ THE REPORT
 

 

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All-Payer Claims Databases: An Overview for Policymakers
May 2010
This brief provides an overview of statewide APCDs and covers the following topics:

  • What are APCDs?
  • In what states do APCDs currently exist and what states are exploring APCDs?
  • Why develop APCDs? • Who are the stakeholders of APCD systems?
  • What are the major concerns or challenges related to APCDs and how they have been addressed?
  • How are states using APCD information?
  • How are APCDs governed and funded?

READ THE BRIEF

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All-Payer Claims Databases in Public Health and Medicaid: A Fact Sheet
2010
All-Payer Claims Databases (APCDs) are large-scale databases that systematically collect health care claims data from a variety of payer sources. States are seeking assistance and tools to promote and strengthen the health and health care delivery for their populations. In establishing APCDs, states have identified several important uses of APCD data.
READ THE REPORT