Authors: Warren Newton, MD MPH; Ann Lefebvre, MSW, CPHQ
Primary care transformation is necessary for health system redesign, but how to support this on a large scale remains unclear. The tasks of contemporary primary care are substantial, and include closing the quality gap and addressing disparities, while lowering total cost of care and increasing patient engagement. At the same, the clinical and organizational environment for primary care has become increasingly challenging, the result of Medicaid expansion, practice acquisition, EHR adoption and changes, meaningful use and (Physician Quality Reporting System) PQRS, commercial insurance incentive plans, ICD 10 and many new developments such as the development of MSPP and clinically integrated networks.
Practice facilitators—also called practice support coaches or quality improvement coaches—are one possible solution. There is ample evidence from research and demonstration projects that practice facilitation can improve quality, access to care and patient satisfaction and health care systems and other organizations are beginning to implement practice coaching programs. Virtually all published experience, however, is in the context of single trials or demonstrations of limited scope and duration and we do not have a detailed picture of practice facilitators as the role has broadened and matured and the clinical environment has evolved.
The overall goal of this proposal is to describe this new profession and assess its economic value to primary care practices, using a successful, stable, not-for-profit statewide model as a benchmark and focusing on meaningful use stage 1 and NCQA PCMH recognition as examples of national recognition programs.
1. To describe the role, training, core competencies and ongoing professional development of practice support coaches.
2. To assess the economic value of practice coaching to primary care practices with respect to meaningful use and PCMH recognition.
Each of the specific aims will yield one or more manuscripts and presentations at national meetings. We believe that the description of the role, competencies, and function of the practice support coaches will yield development of a standardized curriculum, which NC AHEC would plan to put in place as part of its statewide quality improvement initiatives and which will inform a variety of national initiatives.
The role of practice facilitation, both in clinically integrated networks and for independent practices, is a key strategic issue in the development of health systems. Given the major potential role of primary care, both of itself and in coordination of care for transitions and complex patients, practice transformation is crucial, and practice support coaches have the potential to be catalysts for this process.
Alignment with BHW priorities
Developing robust primary care, engaged patients and improvement of quality and cost-effectiveness of care is a key goal of health care reform. The HRSA strategic plan has the following goals:
Goal I: Improve Access to Quality Health Care and Services
Goal II: Strengthen the Health Workforce
Goal III: Build Health Communities
Goal IV: Improve Health Equity
Practice support is one of the most cost-effective strategies available to address goals I, II, and IV.
- Lefebvre A, McCaskill M, Reiter K, Mose J, Fraher E, Newton W. The Role of Practice Facilitators in Meeting the HIT Needs of Rural Practices. Research Brief. January 2017
- Lefebvre A, McCaskill M, Machta R, Mose J. The Role of Practice Facilitators in Meeting the HIT Needs of Rural Practices. Policy Brief. December 2016.