Practice Management and Transformation: Lessons from The Transforming Clinical Practice Initiative

Written by: Mily Schroeder, MS, Ed.D, Jenn Barrett, Stacey Rochman, MBA, Priya Radhakrishnan, MD, FACP

The Transforming Clinical Practice Initiative (TCPi) was designed by Centers for Medicare & Medicaid Services (CMS) to help clinicians achieve large-scale health transformation and has done so by supporting more than 140,000 clinician practices over a four-year period in sharing, adapting, and further developing their comprehensive quality improvement strategies. The Practice Innovation Institute (Pii), one of the 29 TCPi Practice Transformation Network (PTN) grantees, is a partnership between Health Current, the Arizona Health Information Exchange (HIE) and Mercy Care, a not-for-profit health plan contracted with the state’s Medicaid agency to provide managed care benefits for all eligible Medicaid populations. Pii is a peer-based learning network designed to coach, mentor, and assist clinicians and their practice staff in developing core competencies specific to practice transformation. This approach allows practices to become actively engaged in their transformation and ensures collaboration across a broad community of practices, thereby creating, promoting, and sustaining learning and improvement across the health care system. TCPi is one of the largest federal investments intended to support clinician practices through nationwide, collaborative, and peer-based learning networks that facilitate large scale transformation (TCPi).

The three main TCPi drivers of change are:

1. Person and Family-Centered Care Design

2. Continuous Data-Driven Quality Improvement

3. Sustainable Business Operations

The five phases of transformation are to set aims/goals, use data to drive care, achieve progress on the aims/goals, achieve benchmark status and be successful on new payment models in place for health care organizations.

The TCPi framework for transformation centers on the patient, the clinician and the systems of care. The transformation methodology uses continuous quality improvement. It also addresses the importance of using clinician and staff vitality and uses joy at work as one of the metrics. (Fig. 2)

Pii is comprised of primary care, behavioral health, and specialty care providers, clinically integrated networks, Federally Qualified Health Centers (FQHCs), crisis service providers (such as RI International), integrated health homes, and others (Fig. 3). With over 2,500 enrolled clinicians, Pii was committed to a total cost of care reduction of 81.5 million over four years. Central to the TCPi and Pii transformation philosophy is a data-centered approach to population health. In addition, providing structure for Patient and Family Engagement (PFE) activities which help practices attain financial improvements to help them succeed in alternative payment methodologies, such as value-based contracts. Identifying and linking with state and federal initiatives provide practices with low-cost solutions for data acquisition and the identification of high cost/high utilizing patients.  This article focuses on summarizing the achievements of Pii during the last 4 years (Table 1).

Our experience within Pii has shown that exemplary practice management all have an engaged practice leadership that when provided with data and supported by tools for transformation and quality improvement methodology, practice transformation results in improvement of health outcomes and cost savings. Crucial to transformation is a support to practices by the practice transformation consultants, educational webinars, and consultation on quality improvement projects, as well as providing technical support such as access to the HIE. Practice coaching and technical assistance have led to substantial improvements in patients with significant risk factors (including social determinants of health) who are typically high cost, high utilizers of healthcare. Finally, focusing on care coordination with practices has shown a markedly positive impact on reducing unnecessary ED visits and hospital admissions, leading to a reduction in the cost of care.  These interventions can be used to target populations that have high costs and create the springboard for overall sustainable system change. Smaller practices, which might not have access to resources available to larger systems, can avail themselves of state-based resources like the HIE, which will better provide alignment for successful value-based care. Common to all the practices are an engaged vision with practice leadership committed to a culture of improvement.

Table 1 quantitatively summarizes Pii’s achievements to the six aims we committed to at the beginning of the grant. Enrollment, improving health outcomes, reducing unnecessary hospital use, reduce costs, reduce unnecessary testing and procedures, and transformation.

Our experience within Pii has shown that exemplary practices all have in common an engaged practice leadership that provided with data and supported by tools for transformation and quality improvement methodology, practice transformation leading to improvement in health outcomes and cost savings is possible.

References

1. TCPi https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/
2. Practice Innovation Institute http://piiaz.org/

Disclaimer

This project was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

About the Authors

Dr. Priya Radhakrishnan, MD, FACP is a board-certified internist with an interest in treating patients with chronic complex illness and is a physician leader with extensive experience. She has specific expertise in Population Health and Quality Improvement, Medical Education, Health Care disparities, Integrated Care and Health Information Technology. She is the Chief Academic Officer at HonorHealth and oversees the medical education programs at HonorHealth. She is a Clinical Professor of Medicine at the University of Arizona College of Medicine-Phoenix.  She is the physician advisor for the Practice Innovation Institute, a CMS Transforming Clinical Practice Initiative (TCPI) grant. She is currently the national co-champion of the Patient and Family Engagement Work Group (previously Affinity group) for TCPI.

Dr. Radhakrishnan has held several leadership positions. She is the current Governor for the Arizona chapter of the American College of Physicians and a member of the American College of Physicians, Medical Informatics Committee. She was the Robert Craig Academic Chair of Internal Medicine at St. Joseph’s Hospital and Medical Center, Phoenix. Dr. Radhakrishnan received her undergraduate medical degree at Calicut Medical College, India and completed her residency in pathology at Trivandrum Medical College. She then completed her residency at Lincoln Hospital and Mental Health Center and St. Francis Hospital at Evanston. She has received certification in Quality Improvement through the Inter-Mountain Advanced Training Program.

Dr. Radhakrishnan’s clinical and research work with health care disparities, quality improvement, and medical education has been recognized locally and nationally. She was the recipient of the SGIM’s Clinical Practice and Quality Innovation and the AIAMC  2019 National Innovation Award. Dr. Radhakrishnan was recognized as a Master teacher by faculty and residents at St. Joseph’s Hospital and is also a recipient of Phoenix Top Docs, an annual peer-selected list of the Valley’s most respected physicians published in Phoenix Magazine.

 

Mily Schroeder, MS, EdD, PsyD (ABD) is the Government Relations & Compliance Administrator for Mercy Care’s Practice Innovation Institute (Pii). Dr. Schroeder served as the Director of Network Management for Mercy Maricopa Integrated Care, Regional Director for Mountain Health & Wellness, and the Social Science Area Content Chair for University of Phoenix, Yuma branch. She is a contributing author to the book “The use of Cocoa and Cupuacu Byproducts in Industry, Health and Gastronomy”.  Dr. Schroeder has published extensively on different areas and her particular interest is in the management of psychiatric inpatient readmission rates among Hispanics suffering from severe mental illnesses.  She published an article in Spanish, in the Revista Archivos Venezolanos de Farmacología y Terapéutica, titled: “Association of Preventable Medical Conditions, Healthy Nutrition, the Ingestion of Psychotropic Medication and People who suffer from Severe Mental Illnesses.  Another of her main interests is to do research in the area of Diabetes and metabolic syndrome.  She published an article in the Journal of Food and Nutrition Sciences titled: “Biochemical and Anthropometric markers, metabolic syndrome and main dietary habits of a Waraos population sample”.  In addition, over the years she has had the opportunity to present in many different conferences such the Arizona State University (ASU) Summer Institute, the Southwestern Schools for Behavioral Health Studies in Tucson AZ, and the State of the Science Conference in Washington DC in the area of Clinical integration.