ToRCH FAQs

What is ToRCH?

Transformation of Rural Community Health (ToRCH) is an active rural health program sponsored by the Missouri HealthNet Division (MHD), i.e. Missouri Medicaid.  The ToRCH program implements a care model that directs resources to rural communities dedicated to addressing the underlying causes of poor health.  This model integrates social care supports into clinical care, enabling us to leverage existing social care funding and create a sustainable pathway to rural hospitals.  Ultimately, ToRCH aims to improve clinical outcomes for Missouri’s Medicaid population by tackling the social challenges that impact individuals’ health maintenance and chronic conditions management.

The ToRCH project establishes community-based hubs that serve as regional leaders to direct strategy and coordinate the efforts of healthcare providers, community-based organizations, and social service agencies within designated rural areas.  Powered by Unite Us, a national leader in cross-sector collaboration software, the ToRCH project enables partners to effectively manage eligibility and authorization, send referrals to contracted providers, securely track outcomes (closing the loop), document services efficiently, handle reimbursement for social care services, and connect activities to improved health outcomes.

Who can participate in ToRCH?

Through a competitive application process, six rural hospitals were selected as ToRCH hubs for the inaugural cohort in the counties listed below.  As the project evolves, additional rural hospitals and counties may be invited to participate, provided they meet the Federal Office of Rural Health Policy’s definition of rural.  Community-based organizations, as well as health and human services in the target counties, are encouraged to engage with the ToRCH project by reaching out to the respective hub organization.

  1. Dent County - Salem Memorial District Hospital – Salem, MO
  2. Henry County - Golden Valley Memorial Healthcare – Clinton, MO
  3. Pettis County - Bothwell Regional Health Center– Sedalia, MO
  4. Phelps County - Phelps Health – Rolla, MO
  5. Polk County - Citizens Memorial Hospital  – Bolivar, MO
  6. Ray County - Ray County Hospital – Richmond, MO
When did ToRCH go live?

On March 25, 2024, Missouri HealthNet Division received approval from the Centers for Medicare & Medicaid Services (CMS) of its 1915(b) waiver amendment to allow for the full deployment of the ToRCH pilot.  The first cohort of ToRCH hubs is now fully operational, and the hubs are paying for 1915(b)(3) services, known as “b3 services” for short, as of July 1, 2024.

Is there a cost to participate in ToRCH?

Participation in ToRCH is free for community-based organizations within the target counties.  Health and human services organizations in the target counties are invited to join the ToRCH initiative by reaching out to the respective hub organization.  Furthermore, access to the Unite Us platform is also provided at no cost to participating ToRCH partners.

How will the ToRCH program be sustained?

The Missouri HealthNet Division anticipates continuing its funding for the Unite Us platform indefinitely, as long as the ToRCH project is achieving success.  Other ToRCH expenditures at the community level are categorized into two components.  One funding stream, which will remain ongoing, supports hub staffing and data analysis, involving 3-4 full time equivalent (FTE) staff per hub.  The second component focuses on capacity building among selected community-based partners to ensure that capacity exists in the rural community to address specific b3 services.

At the individual level, there are funds to cover model activities such as screening Medicaid participants and referring them to services, as well as covering some of the key b3 services themselves.  For example, the waiver allows reimbursement for medically appropriate meals, nutrition education, supplemental transportation to access certain assistance, and limited home modifications to address health and safety concerns.  Over time, this last funding stream will transition to being supported by shared savings generated from the ToRCH model.

How can ToRCH funds be used by the Hub hospital? By community partners?

Certain ToRCH funds are specifically designated to support hub activities typically conducted within the hub hospital, including leadership development, data analysis, and community partnership management.  Additional ToRCH funds may be allocated to repurpose hospital spaces for community-based organization (CBO) activities.

From the perspective of community partners, capacity-building funds can be used to secure additional space, purchase IT or other necessary equipment, acquire vehicles, and provide training for staff, among other uses.  This funding stream is designed to be flexible, facilitating investments in durable items that enhance the partners’ ability to deliver services.

Moreover, additional ToRCH funds are available to reimburse specific approved health-related social needs that have been identified as necessary based on community assessments within the ToRCH hub counties.  These b3 services include supplemental transportation, food and nutrition assistance and education, home-delivered medically tailored meals, and housing remediation to address health risks.  CBO partners providing these services will receive reimbursement on a per-person per-service basis.

How does a community partner request funding?

Capacity Building funds are not designated for ongoing expenses such as staffing.  However, since there is reimbursement for approved b3 services on a per-service basis, collaboration between the ToRCH hub and community partners regarding service referrals can generate opportunities for funding new positions.

Additionally, priority clinical partners may contribute to hub staffing and data analysis; their time may be supported by a dedicated allocation of FTEs specifically funded for these purposes.

The local Leadership Board, chaired by the ToRCH hospital, will make decisions regarding funding allocations to local partners aimed at achieving designated population health goals.

Each Leadership Board identifies promising Community-Based Organizations (CBOs) interested in fully participating in the ToRCH model.  All hubs have established fair and unbiased processes for CBOs to request funds, evaluating each proposal based on its potential to advance the goals of the ToRCH model in comparison to other proposals.

Once selected for funding, the CBO will be monitored by both the local ToRCH Leadership Board and MHD.  Additional capacity building funding will only be available if initial performance criteria are met, specifically if the CBO engages fully with the Unite Us platform and addresses referrals in a timely manner, according to the standards agreed upon between the CBO and the ToRCH Leadership Board.

What is the duration of the funding?

We anticipate that each ToRCH hub will develop and shift to funding b3 services through shared savings by the fifth year of the model.  While the baseline hub funding (3-4 FTEs) and the Unite Us platform will be supported indefinitely, capacity building funds will no longer be available in the mature model.  Instead, funding for b3 services will come from shared savings achieved by reducing hospital utilization among all Medicaid participants residing in each ToRCH county, which is the primary objective of the ToRCH model.

How do I connect with a ToRCH hub?
What is being done to monitor the success of the model?

The primary goal of ToRCH is to reduce the utilization of emergency room services for Medicaid participants living within the participating counties. Missouri HealthNet will baseline this data within each ToRCH county and monitor it on an annual basis to determine if the upstream efforts of ToRCH are resulting in improvements.

Additionally, each participating hospital collaborated with Missouri HealthNet to identify specific population health goals that they believe could benefit the most from upstream interventions. Examples include, improved well-child visits, controlling high blood pressure and diabetes, and improved follow up visits for participants experiencing mental health issues. These population health goals will also be compared against baseline data on an annual basis.

What data is the state utilizing to monitor the model?

Social determinants of health referral activity is monitored in real-time through the Unite Us closed-loop referral platform. Participating hospitals meet bi-monthly with Unite Us and Missouri HealthNet to discuss trends, barriers, and successes.

Missouri HealthNet has also partnered with our three managed care organizations to receive quarterly data to monitor county-level HEDIS measures so they can be compared over baseline data from the prior year.

Lastly, the Hospital Industry Data Institute (HIDI) has developed internal dashboards based on pre adjudicated hospital claims to provide participating hospitals insight on the clinical risks occurring within their communities. These dashboards provide a comparison between ToRCH counties and other rural Missouri counties and provide key elements to assist with identifying where the highest cost of care is occurring within the hospital. These dashboards are utilized during Leadership Board meetings to inform stakeholders and develop strategies to target upstream efforts to improve health outcomes.