- Advanced Primary Care Practice (APCP) Demonstration Project
- Safety Net Medical Home Initiative
- Primary Care Teams: Learning from Effective Ambulatory Practices (LEAP)
- Regional Improvement Projects
- Transforming Primary Care: Evaluating the Spread of Group Health’s Medical Home
- Group Health’s Partnership for Innovation
- Improving Chronic Illness Care website
Advanced Primary Care Practice (APCP) Demonstration Project
Preparing to care for millions of previously uninsured Americans presents an unprecedented challenge for the nation’s health care “safety net,” a network of federally funded providers that care for nearly 20 million people—more than one in 10 Americans—including low-income, vulnerable patients. The MacColl Center for Health Care Innovation will do its part as technical advisors to the APCP Demonstration Project. The project is an initiative from the Centers for Medicare & Medicaid Services that will help 500 participating federally qualified health centers (FQHCs) to transform their practices into patient-centered medical homes. The goal is to guide 90 percent of participating FQHCs to achieve level 3 patient-centered medical home recognition from the National Committee for Quality Assurance by October 2014.
Using a capacity-building approach that emphasizes leadership development in state Primary Care Associations (PCAs) and the health centers, the MacColl Center and partners will:
- Design, develop, and present training materials—for example, webinars and Web-based tools and guidance on the patient-centered medical home change concepts that can help with sustaining practice transformation
- Foster intra- and inter-regional learning communities through a “network of networks” centered around PCAs, practice transformation facilitators, and sites
- Provide guidance on performance measurement and troubleshooting
- Conduct ongoing needs assessment to meet on-the-ground technical assistance requests.
Safety Net Medical Home Initiative
Since May 2008, the MacColl Center has been working with Qualis Health and The Commonwealth Fund on a five-year demonstration project. The project is helping 65 primary care safety net sites to become high-performing patient-centered medical homes and to achieve benchmark levels of quality, efficiency, and patient experience. In collaboration with a national advisory panel, MacColl developed eight change concepts that encapsulate the changes required for a practice to transform into a patient-centered medical home. Other similar medical home efforts, including the APCP demonstration described above, have adopted these concepts.
The Safety Net Medical Home Initiative received applications for participation from 42 organizations in 31 states. Five Regional Coordinating Centers were selected, and each worked in partnership with 10 to 15 primary care safety net sites in their respective states: Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania. In a “train-the-trainer” model, the Initiative provided these regions with support for practice coaches, technical assistance, resources, and tools.
The MacColl Center’s work for the Initiative has included developing:
- Implementation guides: An online toolkit provides practices with information and resources on eight topics:
- Empanelment (linking patients with specific providers)
- Continuous and team-based healing relationships
- Patient-centered interactions
- Engaged leadership
- Quality improvement strategy
- Enhanced access
- Care coordination
- Organized evidence-based care
- A national curriculum: Aimed at state PCAs and other groups interested in supporting patient-centered medical home transformation, this curriculum includes strategies and tools based on implementation science, quality-improvement evidence, and the Initiative’s Framework for Practice Transformation. Topics will include:
- Building partnerships between a PCA and a practice and establishing a plan of action
- Incorporating contextual factors such as payment and recognition into strategic planning
- Sequencing the transformation process into manageable phases and steps
- Ensuring that measurement is a central part of transformation
- Using learning communities as an effective strategy to support practices going through transformation and beyond
- Maintaining and spreading the changes beyond the active transformation period to foster long-term care improvements.
Developed with sponsorship from The Commonwealth Fund and in close partnership with Qualis Health and the National Association of Community Health Centers, the curriculum will be launched in 2013.
Primary Care Teams: Learning from Effective Ambulatory Practices (LEAP)
How can U.S. primary care practices best adapt their workforce to a rapidly changing health care environment? The MacColl Center aims to find answers as the leader of a national program called Primary Care Teams: Learning from Effective Ambulatory Practices (LEAP). The project began its first phase in March 2012 with a $3.3 million grant from the Robert Wood Johnson Foundation.
LEAP is identifying and visiting 30 high-functioning primary care practices nationwide to study workforce model innovations that can be replicated and adopted widely. Experts nominated more than 400 practices to take part in the program, which is funded through June 2014.
LEAP will study practices in various locations and settings, including small private practices, large health systems, and community health centers. The researchers will focus on training programs, policy changes, and staff arrangements that have improved outcomes for practices and patients. Later, LEAP will help the sites form a learning community to share best practices and distill their innovations into a toolkit that others can use.
MacColl Center Director Emeritus Ed Wagner, MD, MPH, co-directs the LEAP program with Margaret Flinter, PhD, APRN, senior vice president and clinical director of the Community Health Center, Inc., a federally qualified health center in Connecticut. Thomas S. Bodenheimer, MD, MPH, an adjunct professor at the University of California, San Francisco, School of Medicine, chairs the project’s national advisory committee, which has developed the criteria for selecting the primary-care practices that the program will study.
The MacColl Center serves as the project’s national program office.
Regional Improvement Projects
The MacColl Center has provided technical assistance for several regional improvement efforts, including:
- Aligning Forces for Quality: AF4Q is an ambitious effort by the Robert Wood Johnson Foundation in 16 targeted communities. It aims to increase the overall quality of health care, reduce racial and ethnic disparities, and provide models for national reform. The AF4Q regions encompass almost 38 million people, or one in eight Americans, and one in seven primary care physicians in the United States. Begun in 2006, the program intends to drive local change that is expected to show measurable improvements by 2015. MacColl has led technical assistance efforts within ambulatory-care quality improvement initiatives for this program.
- Prescription for Pennsylvania: Rx for PA is a comprehensive reform initiative to address health care access, affordability, and quality. The effort calls for a set of integrated strategies to eliminate inefficiencies in the health care system, better manage chronic conditions, eliminate health facility-acquired infections, implement common-sense
- California Improvement Network: This network’s California Chronic Care Learning Communities Initiative was launched in July 2004 with a California HealthCare Foundation grant to develop learning communities to create and sustain chronic care improvements within the state’s public hospital system clinics. The MacColl Center is among several key partners in the effort, including Kaiser Permanente; Thomas S. Bodenheimer, MD, MPH, of the University of California, San Francisco; and the California Health Care Safety Net Institute.
In addition, the MacColl Center’s Framework for Creating a Regional Healthcare System provides an introductory look at how public and private stakeholders can work together to improve health care at a regional level.
Transforming Primary Care: Evaluating the Spread of Group Health’s Medical Home
Following a positive evaluation of Group Health’s patient‑centered medical home model of primary care in 2010, Group Health leadership decided to spread the model to all 26 of its medical centers. With funds from the Agency for Healthcare Research and Quality, the MacColl Center is studying this widespread implementation, evaluating its impact on cost, utilization, and quality of care. Robert J. Reid, MD, PhD, Group Health’s associate medical director for research translation, is leading the evaluation.
Group Health’s Partnership for Innovation
The Partnership for Innovation is a Group Health Foundation donor-funded grants program that gives Group Health staff members an opportunity to pilot-test cost-effective improvements to patient care. The MacColl Center staff provides technical assistance to the program, which has funded more than 25 projects with over $2 million since it began in 2008.
Improving Chronic Illness Care website
As the national program office for the Robert Wood Johnson Foundation’s Improving Chronic Illness Care (ICIC) initiative from 1998 until 2011, the MacColl Center has developed a robust online library of resources. The Center continues to support and develop this popular ICIC website, which includes literature reviews, learning guides, and toolkits on topics such as the Chronic Care Model, care coordination, practice change, the patient-centered medical home, and regional quality improvement.