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
Traversing Together: Finding Success in Chaos
The NH Citizens Health Initiative virtual 2022 Symposium reflected on the experiences of families, providers, organizations, and communities in the last few years, exacerbated by the challenges presented by the COVID-19 pandemic and highlighted the success and strategies utilized across sectors from an individual, organizational, state, and national perspective. We hope the sessions throughout the day provided you and your organization opportunities to share learning, to connect and to energize as we move forward health and health care for all in New Hampshire. Read more
Projects and Initiatives
The mission of the NH Citizens Health Initiative is to measurably improve the systems that finance and provide health care in New Hampshire, by providing trusted leadership, data, and shared learning with the goal of achieving the quadruple aim: achieving better health outcomes, with a better patient care experience, at a lower cost, and with higher provider satisfaction.
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.
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:
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Identify real-time needs of rural communities and science-supported methods for effectively addressing current and future addiction needs.
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Deliver ongoing technical assistance and workforce training to support the effective use of best practices for assessing and treating rural patients.
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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 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)
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
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.
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)
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.
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:
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Expand the primary care workforce pipeline for rural and underserved populations
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Enhance preceptor knowledge and confidence by sharing best practices and case studies combined with shared discussions, recommendations, and resources
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Provide tools and shared experiences/innovations for practice efficiency while precepting students
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Boost professional connections and create a supportive community among preceptors in New England and beyond
Resources and Publications
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New Hampshire Child and Teen Mental Health: An Analysis and Comparison of 2019-2020 Healthcare Claims Data |
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Chronic Pain Self-Management Project ECHO Series: Evaluation Highlights |
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New Hampshire Children and Teens Experiencing Mental Health Disorders: An Analysis of 2019 Healthcare Claims Data
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Facilitating a Quality Improvement Approach to Childhood Adversity Screening in Primary Care: A Handbook 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. |
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A Guide to Trauma Informed Pediatric Primary Care 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. |
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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. |
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UVM CORA NH BNA COVID-19 Impact on Substance Use and Treatment Data Brief |
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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 |
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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 |
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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. read the report |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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All-Payer Claims Databases: An Overview for Policymakers
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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 |