Center for Evidence-based Policy Innovation Award Winners

Missouri ToRCH Project 

(Pictured: Michelle Kohrmann, Pam Curtis, Lori Melvin, Fatimah Jennings, Timothy Kling)

The ToRCH (Transformation of Rural Community Health) Project was designed and created by the Office of Transformation within MO HealthNet (Missouri Medicaid) to address interlinked challenges in rural communities: rural hospitals were struggling financially, impairing their ability to serve the members of their communities. At the same time, members of these rural communities faced many social care challenges that compromised their ability to maintain their health and effectively manage chronic conditions. 

ToRCH is a primary care case management (PCCM) pilot program operating in 6 rural counties in Missouri, created through an amendment to the state’s 1915(b) waiver. In June of 2023, 6 rural hospitals were selected to lead the project by convening and managing a local leadership board composed of representatives from the hospital, primary care and behavioral health clinics operating in the county, and community-based organizations offering social services. Together, each county team works to screen Medicaid enrollees for social care needs, refer individuals for services, track delivery of services, handle reimbursement for services, and track individual Medicaid member health-related outcomes. 

Overview 

The MO HealthNet provided 4 funding streams for the project. Administrative funds are available for expenses related to convening each region’s leadership board, monitoring Medicaid claims data, conducting data analysis, and overseeing the initiative. Capacity-building funds were made available during the initial model years to enhance service capacity. Reimbursement is provided for screenings for social care needs and funding is provided to deliver 1915(b) social care need services such as expanded non-emergency transportation; nutritional counseling and education; home-delivered, medically tailored meals; and environmental modifications of Medicaid member’s homes. 

Data Sources 

The ToRCH project relies on 3 data sources to support the initiative and track outcomes. First, all social need screenings, referrals, and delivery of services are tracked through the Unite Us closed-loop referral platform, which is available to hospitals, primary care and behavioral health clinics, and community-based organizations. Second, each pilot site worked with Missouri Medicaid to choose specific population health goals to track, and the managed care organizations provide quarterly county-level data to monitor progress toward goals using standard HEDIS measures. Finally, the Hospital Industry Data Institute developed dashboards that allow participating hospitals to gain insight into the clinical needs and risks of their community members and compare their data with other rural Missouri counties. 

Outcomes 

In the first 2 years of the pilot, the ToRCH project reported significant improvements in the following health-related outcomes: expanded access to community-based services to address health-related social needs; improvement in hypertension management and hemoglobin A1C control for patients with diabetes; significantly improved follow-up care for high-risk psychiatric and substance use disorder patients following emergency department discharge; and increased enrollment of pregnant women in the Women and Infants and Children (WIC) program. In addition, the pilot sites met targets for reducing preventable emergency department visits and avoidable 30-day hospital readmissions, and reported overall savings related to addressing health-related social needs for Medicaid members. The program has received attention from health services researchers and journalists and was included in the grant announcement for the Rural Health Transformation Program as a notable example initiative. 

Honorable Mention: Wisconsin GLP-1 Weight Management Benefit 

(Pictured: Pam Curtis, Jeff Huebner)

Wisconsin Medicaid developed a comprehensive coverage policy for the use of GLP-1 drugs for weight management. Drawing on evidence reports produced by DERP and MED, Medicaid staff conducted an analysis of GLP-1 utilization and expenditures and modeled what would happen under a broader coverage policy. They then engaged a contractor to financially model an optimum cost per prescription to expand coverage and collaborated with an external weight management advisory committee to develop clinical criteria for the new policy. Finally, they worked with drug manufacturers to select preferred GLP-1 medications and negotiate pricing. Effective July 1, 2026, Wisconsin Medicaid implemented the new coverage policy, which provides GLP-1 medications for Medicaid members with a BMI greater than or equal to 30 or a BMI between 27 and 30 with at least 2 risk factors. Wisconsin Medicaid staff plan to evaluate the impact of the coverage policy through analysis of claims data and other information to track member outcomes and program costs.