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 on August 12 as a special supplement to the Annals of Family Medicine. The collective body of work, funded by the Centers for Medicare and Medicaid Services (CMS), 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 (TCPI) to help transform the U.S. 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 U.S. 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 the TCPI. Section 5405 of the Patient Protection and Affordable Care Act authorized the Primary Care Extension Program, which was modeled after the U.S. Department of Agriculture’s (USDA) 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.
- A Longitudinal Study of Trends in Burnout During Primary Care Transformation by Kevin Grumbach, et al, San Francisco, California
- Clinician Perspectives on the Benefits of Practice Facilitation for Small Primary Care Practice by Erin Rogers, DrPH, et al, New York, New York
- Practice Transformation Under the University of Colorado’s Primary Care Redesign Model by Peter Chabot Smith, MD, et al, Aurora, Colorado
- Transformation Support Provided Remotely to a National Cohort of Optometry Practices by Ronald Adler, MD, et al, Worcester, Massachusetts
- A Randomized Trial of External Practice Support to Improve Cardiovascular Risk Factors in Primary Care By Michael Parchman, MD, MPH, et al, Seattle, Washington
- Differences In Team Mental Models Associated With Medical Home Transformation Success by Lee Green, MD, MPH, et al, Edmonton, Alberta
- Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine by Jocelyn Charles, MD, MScCH, et al, Toronto, Ontario
- Facilitating Practice Transformation in Frontline Health Care by Robert Phillips, Jr, MD, MSPH, et al, Lexington, Kentucky
- Contribution of the Transforming Clinical Practice Initiative in Advancing the Movement to Value-Based Care by Meena Abraham, DrPH, MPH and Paul McGann, MD, Baltimore, Maryland
- The Role of Health Extension in Practice Transformation and Community Health Improvement: Lessons From 5 Case Studies by Arthur Kaufman, MD, et al, Albuquerque, New Mexico
- Practice Transformation Analytics Dashboard for Clinician Engagement by Niharika Khanna, MD, MBBS, DGO, et al, Baltimore Maryland
- Supporting Physicians & Practice Teams in Efforts to Address the Opioid Epidemic by Lisa M. Letourneau,MD, MPH, et al, Augusta, Maine
- Clinicians’ Overestimation of Their Geographic Service Area by Robert Rock, MD, et al, Bronx, New York
- Improved Outcomes Associated With Interprofessional Collaborative Practice by Thomas P. Guck, PhD, et al, Omaha, Nebraska
- Coaching Small Primary Care Practices to Utilize Patient Portals by Lauren Gritzer; MPH, et al, Baltimore, Maryland
- An Empanelment Toolkit for the Safety-Net Clinic Setting by Stella Gukasyan, EdM, and Mike Wong, MPH, San Diego, California
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.