Transforming clinical practice

Sunday, November 01, 2015 11:26 AM

New opportunity to communicate, connect and deliver care

by Carol Greenlee, MD, Western Slope Endocrinology, and Allyson Gottsman, Colorado Health Extension System

The state of Colorado is one of 29 regions recently awarded a grant from the Center for Medicare and Medicaid Innovation (CMMI). This “Transforming Clinical Practice Initiative” gives Colorado physicians an opportunity to test alternative approaches to care delivery and provide input into the restructuring of the health care system, utilizing models developed by practicing clinicians.

The initiative comes at a critical time. Advances in medical science continually transform the way conditions are diagnosed, treated and cared for each day. This expansion of medical knowledge offers the potential for better health as well as preventive opportunities; however, systems of care have not changed adequately to adapt to and support these advances and their associated demands. Nor have medical systems or individual practices adapted well to the even more rapid changes in technology in our society. Attempting to simply add all of these changes into and on top of current, long-standing methods of care delivery has resulted in marked increases in the burden of care borne by most clinicians with more chaos, fragmentation and disconnection within the system.

As a result, we are seeing not only huge gaps in care with missed opportunities to apply the advancements in scientific knowledge, but also excessive duplication of care and unnecessary (low value) care. The costs in terms of clinician frustration and burnout, can’t be sustained without weakening the health care system.

A mandate to move to value-based payment will require practices, hospitals and other providers to demonstrate the value of the care they deliver. From a preliminary glance, these expectations appear to just pile more straws on that overburdened camel’s back of already collapsing medical clinicians.

Not just for primary care
All Colorado physicians are invited to join this initiative and the Colorado Practice Transformation Network. The goal is to engage 2,000 clinicians, from specialists and primary care physicians to physician assistants and advanced practice nurses.

This project will develop new and improved systems to reduce the burden of care by practice reorganization and better use of technology to capture data needed to not only meet the upcoming mandates but also to assist with reducing the gaps and the waste in the current system. Importantly, the initiative aims to reconnect care between all providers through improved communication, coordination and continuity both within a practice and/or institution as well as between them.

Participation has its privileges
Participating practices will enjoy the benefit of being a part of a vibrant learning network, working with peers across Colorado to share best practices and prepare for value-based payment. Successful compensation models in the very near future will require greater communication and collaboration among physicians caring for the same patients, reducing duplication of testing, and proactively managing complex patients to provide care in the most cost-efficient setting.

High-value referrals mean effective use of resources – the right patient, with the right data, seeing the right specialist, with the right allocation of specialist time. Optimizing the referral process means more access to more specialists by not taking up time with inappropriate or unproductive consults. Enhanced access reduces delays in treatment, reduces duplicate testing, improves the health of patients and has a positive financial impact all around. It’s a win, win, win.

The final program elements are still a work in progress among the many practice transformation organizations across Colorado. Perry Dickinson, MD, at the Department of Family Medicine, is leading the initiative while working with the Colorado Health Extension System, a collaboration of over 20 Colorado organizations committed to improving health and health care. When the program details are finalized and we are ready to enroll physicians in the program, the Colorado Medical Society will be your source for accurate and timely information.

In the meantime, refer to the Centers for Medicare and Medicaid Innovation website, www.innovation.cms.gov/initiatives/Transforming-Clinical-Practices, or contact allyson.gottsman@UCDenver.edu.