Transforming clinical practice

Friday, January 01, 2016 12:26 PM

TCPi model will assist clinicians with practice support on quality and process improvement

by Kyle Knierim, MD, and Barbara J. Martin, RN, MSN, ACNP-BC, MPH,

Much has been written about the Triple Aim since Don Berwick first introduced it in 2007. The Triple Aim – enhancing patient experience, improving population health, and reducing costs – is widely accepted as both a guidepost and a measure of success in transforming our broken health care system. In the past year we have heard more and more about the quadruple aim, recognizing that quality health care needs to involve the well-being of the health care team. In order to truly evolve into a system of quality and value, we must develop the infrastructure and support that will empower providers to be the leaders in delivery system redesign.

The good news is there is widespread agreement. At the Centers for Medicare and Medicaid Services National Quality Conference: Building Partnerships, Delivering Results in Baltimore earlier this month, more than 2,000 individuals came together to celebrate the successes we have achieved and lay out a road map for the future of health care redesign; the care team was at the front and center of the conversation.

This conference served as the kickoff for the Transforming Clinical Practices Initiative (TCPi) funding opportunity, a four-year grant from the Centers for Medicare and Medicaid Services. As reported in the November/December issue of Colorado Medicine, the TCPi model will assist clinicians in improving how care is delivered by providing practice support to adopt a culture of quality and process improvement. TCPi will build on and spread proven change management methodologies and practice redesign tools to ensure health systems and providers can be successful in value-based payment models. TCPi has the following aims.

• Support more than 140,000 clinicians.
• Improve health outcomes for millions of patients.
• Reduce unnecessary hospitalization for 5 million patients.
• Generate $1 billion to $4 billion in savings.
• Sustain efficient care by reducing unnecessary tests and procedures.
• Build an evidence base for transformation.

To achieve these aims, TCPi funds two types of collaborative networks – Practice Transformation Networks and Support and Alignment Networks.

Through a collaborative partnership among many local and regional organizations across the state, Colorado was selected as one of 29 Practice Transformation Networks (PTNs). The Colorado PTN will coordinate peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice redesign. This approach allows clinicians and practices to become actively engaged in the transformation and ensures collaboration among a broad community of practices that creates, promotes, and sustains learning and improvement across the health care system.

The 10 Support and Alignment Networks (SANs), which include organizations such as the American Medical Association and the American College of Radiology, will provide a system for workforce development utilizing national and regional professional associations and public-private partnerships that are currently working in practice transformation efforts. Utilizing existing and emerging tools (e.g., continuing medical education, maintenance of certification, core competency development, data and HIT assistance) these networks will help ensure the sustainability of these efforts. These will especially support the needs of practices serving small, rural and medically underserved communities.

While at first glance this may look like just another case of acronym soup, the Colorado PTN has been developed to add value to and support delivery system redesign that is already underway and to do so with a lens of supporting the care team – ensuring that the infrastructure and tools and resources are in place for providers and staff to not only survive but also thrive with a sense of professional wellbeing in the midst of the ever-changing health care landscape.

Change is coming, most notably in the form of payment reform as laid out in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. As we await the final rule that will guide MACRA, slated to come out this spring, take note that the Centers for Medicare and Medicaid Services and the Colorado community do not want practices to go it alone. The Colorado PTN, in alignment with the other opportunities for practice transformation in the state, are committed to this support.

Stay tuned as we continue to highlight TCPi in the months to come, and particularly the partnerships with many of the SANs (see the complete list in the sidebar on the previous page). Notably, the American Medical Association is partnering with the Colorado PTN and the Colorado Medical Society to host a learning and network event on Jan. 29 to present the Colorado PTN model. More details will be available in the coming weeks. In the meantime, for more information or to get involved please contact the Colorado PTN Program Manager at barbara.martin@state.co.us or visit https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices.

Five phases of transformation to achieve TCPi aims and goals:

• Setting aims and developing basic capabilities
• Reporting and using data to generate improvements
• Achieving aim of lower cost, better care, better health
• Getting to benchmark status
• Capacity to generate better care, better health at lower cost

Support and alignment networks

• American College of Emergency Physicians
• American College of Physicians, Inc.
• HCD International, Inc.
• Patient Centered Primary Care Foundation
• The American Board of Family Medicine, Inc.
• Network for Regional Healthcare Improvement
• American College of Radiology
• American Psychiatric Association
• American Medical Association
• National Nursing Centers Consortium

Jan. 29, 2016 Colorado TCPi kickoff learning and network event featuring:

Carol Greenlee, MD, FACE, FACP, an endocrinologist and national leader on building the medical neighborhood through coordination and high-value referrals.

Christine Sinsky, MD, vice president of professional satisfaction, American Medical Association, national leader on practice redesign and physician satisfaction and a board-certified internist practicing at Medical Associates Clinic and Health Plans in Dubuque, Iowa.