As the new decade began, it quietly marked the end of an ambitious four-year CMS project that had a significant impact on healthcare practices. The Transforming Clinical Practice Initiative (TCPI) was designed to support more than 140,000 clinician practices in sharing, adapting and developing comprehensive quality improvement strategies and to help them get ready to participate in alternative payment models.
As its website states, the four-year initiative has concluded, but CMS will continue to provide access to the tools and resources for clinical practice transformation that emerged from the experience of the TCPI Community of Practice to allow clinicians and practices to consider adopting the principles and strategies that have proven effective in transforming clinical practices nationwide for improved healthcare delivery and patient outcomes.
Perhaps in the future CMS will publish a full analysis of the impact of the $685 million TCPI program. It relied on Practice Transformation Networks (PTNs), peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice transformation. This approach was designed to allow clinician practices to become actively engaged in the transformation and to ensure collaboration among a broad community of practices.
Among the goals were to:
• Build an evidence base on practice transformation so that effective solutions can be scaled. To achieve this, TCPI was designed to develop, capture, and report a standard set of measures, aligned with the overall goals of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program. Best practices and lessons learned were shared to support practice transformation and practice transitions into alternative payment models.
• Improve health outcomes, reduce unnecessary hospitalizations, and reduce overutilization of other services for 5 million Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries and other patients; and
• Sustain efficient care delivery for Medicare, Medicaid, and CHIP beneficiaries by preparing at least 75 percent of practices that complete the TCPI phases of transformation to move into alternative payment models.
The following 29 organizations were awarded cooperative agreements to serve as PTNs:
• Arizona Health-e Connection
• Baptist Health System, Inc.
• Children's Hospital of Orange County
• Colorado Department of Health Care Policy & Financing,
• Community Care of North Carolina, Inc.
• Community Health Center Association of Connecticut, Inc.
• Consortium for Southeastern Hypertension Control
• Health Partners Delmarva, LLC
• Iowa Healthcare Collaborative
• Local Initiative Health Authority of Los Angeles County
• Maine Quality Counts
• Mayo Clinic
• National Council for Behavioral Health
• National Rural Accountable Care Consortium
• New Jersey Innovation Institute
• New Jersey Medical & Health Associates dba CarePoint Health
• New York eHealth Collaborative
• New York University School of Medicine
• Pacific Business Group on Health
• PeaceHealth Ketchikan Medical Center
• Rhode Island Quality Institute
• The Trustees of Indiana University
• VHA/UHC Alliance Newco, Inc.
• University of Massachusetts Medical School
• University of Washington
In a recent blog post, Robin Moody, executive director of one of the PTNs — the National Rural Accountable Care Consortium — reflected on her organization’s experience, and her account provides a good snapshot of the progress made.
Over the four years of the program, National Rural worked with more than 12,000 clinicians at 2,700 primary care and specialty care clinics in 43 states.
“Because we enrolled and served the smallest and most vulnerable clinics -- practices from medically under-served regions comprised 80 percent of our client base and half our clients were rural clinicians -- our interventions have had the unique benefit of positively impacting communities and regions with higher disease burdens and limited access to local care, including general shortages of primary care, specialty care, and mental health care providers,” Moody wrote.
National Rural’s practice-improvement team assisted clinical practices to implement preventive care and population health workflows though monthly coaching calls and site visits. They were able to nearly triple the average percentage of patients enrolled in chronic care management programs (to 6.1 percent). Clients also increased the rate of annual wellness visits completed for patients to 30.5 percent, from a baseline of 21.5 percent prior to clinics’ program entry.
“Although more than 20 percent of our practices had sub-optimal electronic health records systems (or had no electronic health records at all) and nearly a quarter were solo-practitioners,” she wrote, “we helped them make substantial improvement on all 10 health care quality measures we tracked, with particular success on control of diabetes and hypertension, and on preventive screenings for depression.”
The National Rural Accountable Care Consortium also assisted clinicians transition to value-based payment models: It helped 7,287 clinicians move to new payment models including Medicare ACOs and the CPC+ Program.
“Perhaps the best news of all is that the clinical changes in place at practices we served are likely to stick after the completion of our coaching work with clinics,” she wrote. “In the end, the clinics we served were able to care for more patients thanks to clinical efficiencies we taught, including nurse-led annual wellness visits, and they offered more preventive and care-management services thanks to our individualized coaching. In short, National Rural’s proudest legacy is better care everywhere. We have a lot to be proud of.”
