LEAWOOD, Kansas--Early findings from two major federally funded initiatives aimed at accelerating the development and dissemination of health care innovation in the United States were published today as a special supplement to the Annals of Family Medicine . The collective body of work, funded by the Centers for Medicare and Medicaid Services, will help inform how the United States will support medical practice transformation and community health improvement efforts in the years ahead.
In 2015, CMS launched the Transforming Clinical Practice Initiative to help transform the US health care system to one that rewards value over volume. The four-year, nearly $700 million initiative linked more than 140,000 clinicians in all specialties through networks designed to coach, mentor and assist practices in developing the core competencies required to successfully participate in value-based payment arrangements. TCPI also facilitated connections with national and regional professional associations and public-private partnerships to ensure the sustainability of transformation efforts through the active engagement of specialty societies.
The Agency for Health Care Research and Quality's EvidenceNOW initiative received $112 million in grant funding to help primary care practices across the country more rapidly improve the heart health of Americans. Specifically, aligned with the US Department of Health and Human Services Million Hearts® initiative, EvidenceNOW aimed to reduce the research-to-practice delay in implementing best practices to deliver the ABCS of cardiovascular disease prevention: aspirin in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation.
The special report by Kaufman et al in this supplement reminds us of the important history behind EvidenceNOW and TCPI. Section 5405 of the Patient Protection and Affordable Care Act authorized the Primary Care Extension Program, which was modeled after the US Department of Agriculture's Cooperative Extension Program. That USDA program revolutionized farming in the United States over the last century by testing and speeding dissemination of innovation and best practices. Its application to health care was pilot-tested by the Regional Extension Centers under the Health Information Technology for Economic and Clinical Health Act of 2009. The success of that pilot program inspired the design of EvidenceNOW and further supported the decision by CMS to invest in the TCPI demonstration project.
This supplement to the Annals of Family Medicine combines early findings from multiple examples of health extension and practice transformation support. The supplement consists of seven original research articles, one research brief, three special reports, three one-page innovations in primary care, and two commentaries from nationally recognized experts in primary care research and practice transformation.
Original research findings include:
A Longitudinal Study of Trends in Burnout During Primary Care Transformation
By Kevin Grumbach, et al , San Francisco, California
http://www.annfammed.org/content/17/Suppl_1/S9
Clinician Perspectives on the Benefits of Practice Facilitation for Small Primary Care Practice
By Erin Rogers, DrPH, et al , New York, New York
http://www.annfammed.org/content/17/Suppl_1/S17
Practice Transformation Under the University of Colorado's Primary Care Redesign Model
By Peter Chabot Smith, MD, et al , Aurora, Colorado
http://www.annfammed.org/content/17/Suppl_1/S24
Transformation Support Provided Remotely to a National Cohort of Optometry Practices
By Ronald Adler, MD, et al , Worcester, Massachusetts
http://www.annfammed.org/content/17/Suppl_1/S33
A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care
By Michael Parchman, MD, MPH, et al , Seattle, Washington
http://www.annfammed.org/content/17/Suppl_1/S40
Differences In Team Mental Models Associated With Medical Home Transformation Success
By Lee Green, MD, MPH, et al , Edmonton, Alberta
http://www.annfammed.org/content/17/Suppl_1/S50
Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine
By Jocelyn Charles, MD, MScCH, et al , Toronto, Ontario
http://www.annfammed.org/content/17/Suppl_1/S57
EDITORIALS
The articles published in this supplement tell a story of practices needing relationships and real support in achieving meaningful improvement, if not fundamental transformation. The researchers offer insight for helping practices make use of technology to strengthen relationships with patients and to offer complex patients expanded services. They bring to the fore the complexity and spectrum of practice culture and the need to meet them where they are in order to help the difficult process of change.
This editorial provides context about the ongoing TCPI test model to help readers understand the broader effort addressed by the quality improvement articles in this supplement. To put patients first, CMS is working in concert with partners in the private, public, and nonprofit sectors to transform the nation's health care system to one that rewards value over volume, more closely aligning payment with the quality of care. One way to do this is through alternative payment models, payment approaches developed in partnership with the clinician community that provide added incentives for delivering high-quality, cost-efficient care. To ease the transition for practices, CMS launched TCPI to prepare them for success in achieving outcomes to demonstrate APM success and improvements critical to practice success. The TCPI service delivery (nonpayment) model ends in September 2019, and the continuation of practice transformation and commitment to value-based care rests with the professional associations and clinical practice that took part in the initiative. Although continued efforts will be necessary to move toward a value-based system in the future, the TCPI Practice Transformation Networks and Support and Alignment Networks have identified best practices for preparing both primary care and specialty care clinicians for participation in APMs. Practices that graduated from TCPI are well positioned to participate in APMs, including in the new models announced by the CMS Innovation Center.
http://www.annfammed.org/content/17/Suppl_1/S67
SPECIAL REPORTS
http://www.annfammed.org/content/17/Suppl_1/S73
http://www.annfammed.org/content/17/Suppl_1/S77
RESEARCH BRIEF
http://www.annfammed.org/content/17/Suppl_1/S63
INNOVATIONS IN PRIMARY CARE
Brief one-page articles that describe novel innovations from health care's front lines.
http://www.annfammed.org/content/17/Suppl_1/S82
http://www.annfammed.org/content/17/Suppl_1/S83
http://www.annfammed.org/content/17/Suppl_1/S84
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About the Annals of Family Medicine
Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article can be accessed free of charge on the journal's website, http://www.annfammed.org .
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