Practice transformation

Tuesday, November 01, 2016 12:28 AM
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Engaging clinicians in fixing the flawed health care system

by Carol Greenlee, MD, FACE, FACP

Greenlee Carol

Many of us in the medical field recognize that the health care system is fragmented, disorganized and inconsistent, and it often seems to work against our efforts to deliver high-quality care. Much of this can be attributed to the design of our health care model and its inability to meet today’s demands. The current model was built around acute care needs with silos of care and physicians carrying most of the responsibility for the quality of care delivered. Asking health care workers to try harder in the current system is not the answer. In fact, it is only because our physicians, nurses and other health care staff work so hard, despite the flaws in the system, that we are doing as well as we are with health care. Instead of pounding on medical care providers to try harder and work harder, we need to change the model and the way we do our work to reduce burden and improve effectiveness. This change in the way we deliver care is referred to as practice transformation.

We have needed to improve on our care delivery system for some time, but now with the change in payment models from fee-for-service to more value-based payment, physicians who make needed changes will be financially rewarded for their efforts. In addition, they will likely also find practice more enjoyable and less of a burden.

We all strive to provide the highest quality of care, but our best intentions can be lost in the process. Learning ways to build in those good intentions, such as use of team care and standing orders, can result in more consistently getting the results we want. With the new payment models, we need to look at how we are doing on practice parameters (such as quality measures and cost of care) and if those parameters are not where we want them, we need to have a method to improve them. This is about ensuring that our patients get the care they need and that we intend them to have. It is also about helping to eliminate waste that drives costs without adding benefit for our patients.

Primary care practices have had help transforming the way they deliver care for about a decade. They have been testing the best ways to change their work so it is less burdensome and more effective, which involves teamwork. Many of these changes have led to an advanced patient-centered medical home model and new methods of paying for primary care that support the additional team members and efforts.

A focus on specialists
Now we need to determine what transformation changes will benefit the diverse array of specialty practices and the care they provide to patients. We need to discover what practice elements need to be redesigned and how best to do it. We know that improvements are needed in how we work together, how we share the care of patients and how we communicate with each other. We recognize that everyone will benefit from connected care versus silos but we need to discover what else can be redesigned to help specialty practices provide care better.

The Transforming Clinical Practice initiative (TCPi) offers grant-funded support to help practices make these changes. This initiative is funded by the Medicare and Medicaid Innovation Center (CMMI) to test new payment models, such as bundled payments and accountable care organizations (ACOs). When the Medicare Access CHIP Reauthorization Act (MACRA) was passed in early 2015, CMMI recognized that many, if not most, clinicians and their practices were not prepared to successfully meet the new requirements, such as managing their quality and costs to meet benchmark goals. In response, CMMI devoted funding to this initiative to help practices implement needed changes (transformation) to meet the requirements of the new payment models and improve patient outcomes, reduce unnecessary emergency room visits and hospitalizations, as well as help reduce burnout and improve satisfaction for clinicians. CMMI staff members plan to learn from the practices that participate in TCPi as they share what works and what doesn’t work for care delivery redesign.

Get the support you need
Specialty practices that participate in TCPi will get the support they need to meet the requirements for the merit-based incentive payment system pathway of the MACRA law and the quality payment program that enacts the law. It also will help practices participate in alternative payment models, such as bundled payments or episodes of care, as well as new models on the horizon.

TCPi participation also allows a specialty practice to improve operations and to help determine the best way to do things instead of doing what others think is best. In other words, participation in TCPi helps a specialty clinician and his or her practice drive the bus instead of being taken for a ride on how practice work can be done more effectively and efficiently. It will help practices improve their referral processes and communications, to allow us to work together in the new models of care and payment, to more effectively meet the needs of patients.

TCPi participants will get help selecting specialty measures that best reflect what they do. They will get help in how to look at the data on these measures and work to improve any measures that show gaps. Practices will learn how to look at service utilization data as well as cost data to help them prepare for future opportunities to participate in value-based payment plans. Medicare is moving toward new value-based compensation models, and so are commercial payers and even Medicaid.

These shifts in the way health care will be paid for give us an opportunity to shift the way we practice to one more supportive of our efforts. TCPi supports practices as they make the changes required for future success; it provides resources to help with new approaches and provides a platform for clinicians to share what works and doesn’t work.

Learn more about TCPi, a national initiative that is available to specialists and primary care physicians in Colorado:

Carol Greenlee, MD, FACE, FACP, is the owner of Western Slope Endocrinology in Grand Junction, and serves as state and national faculty for TCPi. Listen to Greenlee talk with Barbara Martin, RN, MSN, ACNP-BC, MPH, director, Colorado State Innovation Model, and Allyson Gottsman, program manager, Colorado Health Extension System about her practice’s transformation efforts and her work with TCPi:

Posted in: Colorado Medicine | Practice Evolution | Practice Redesign


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