The year ahead promises to be a very exciting one in healthcare. While the new federal administration and Congress hatch plans to unwind elements of the Affordable Care Act, I believe that there will be continuing emphasis on efforts aimed at improving quality, increasing patient and family engagement and decreasing the escalation in per-capita cost of healthcare in the United States. And I’m thrilled that HealthTeamWorks® is supporting thousands of medical practices and clinically integrated healthcare networks, both in Colorado and around the country, in initiatives and collaborative learning communities striving toward those aims.

Just a quick reminder that for primary care practices in Colorado, enrollment for EvidenceNOW Southwest (ENSW), is currently open and ends February 15, 2017. Enrollment also begins soon for the second cohort of primary care practices in the Colorado State Innovation Model (SIM) initiative, and some spots for primary care and specialty practices are still available in the Transforming Clinical Practice Initiative (TCPi). Each of these federally-funded innovation pilot programs is unique, but for qualifying practices and health centers, HealthTeamWorks® provides practice transformation, quality improvement and behavioral health integration support, including on-site practice facilitation and coaching, expert consultation, shared learning activity, and electronic health record support – at no cost to practices and health centers. We can help you figure out which program(s) are best suited for your practice, and help guide you through the application process.

Through these federal initiatives, combined with our service to primary care residencies, participants in the BC3 initiative and the Comprehensive Primary Care initiative, plus many other programs and projects, our team was blessed to work with more than 200 practices and clinical networks in 2016. Their efforts resulted in solid process improvements and triple aim performance outcomes, which are described on our website. This year, HealthTeamWorks® will provide learning activity support for thousands of additional practices participating in the Comprehensive Primary Care + initiative in 14 regions around the country. We will also offer advanced healthcare workforce development training and education programs, expand our clinical network performance evaluation and improvement services, and introduce new ways for providers, payers and health communities to obtain access to HealthTeamWorks® resources and services.

I believe that no matter what policy and legislative changes are implemented in state and federal government in the years ahead, the transformation will continue from an episode-based sick care system to a value-based health system that reduces per-capita cost of care and improves population health. It will be remain imperative that primary care be more comprehensive and patient-focused; that patient care across the continuum of healthcare services be more accessible, better integrated and more effectively coordinated; that providers become increasingly accountable for delivering quality care, fostering patient engagement and bending the cost curve; that providers find joy in practicing medicine; that provider organizations thrive financially under the models through which they’re paid; and that we all live in communities in which healthcare services, social safety net services and public health are robust, well integrated and high performing. Managing the health of patients, as well as the population in our communities, regions and the nation requires all of the above, and optimizing the performance of primary care practice remains the essential foundation for transforming the delivery system.

Advanced Primary Care Practices (PCPs) continuously improve patients’ access to both care and the information patients’ need to make decisions about their health. They help patients understand and use technology to help them maintain good health and manage their chronic conditions. They use technology to drive performance improvement efforts and measure outcomes, and to replace avoidable in-person visits with online and telephonic patient care. They work with specialists to develop and implement care plans for their sickest patients, and those with chronic conditions. They integrate primary care with behavioral healthcare and oral health. Advanced PCPs coordinate the care their patients receive both inside and outside their clinical networks, and from community-based organizations. They proactively reach out to patients to assure they’re providing the appropriate standard of care for each one, and that none is falling through the cracks. High-performing PCPs are doing all this effectively and efficiently – they’re providing quality care, generally improving their patients’ health and influencing wiser utilization of healthcare resources. They are capable of thriving under the Merit-based Incentive Payment System (MIPS), Medicare Advanced Alternative Payment Models (AAPMs), and risk-sharing contracts with commercial health insurance carriers.

Advanced PCPs are making every effort to assure that patients receive the right care at the right time by the right provider, supported by the right data in the right environment. Their providers have meaningful relationships with their patients and practice medicine the way they know it should be practiced. And their patients feel informed and engaged in making the decisions that influence their health and quality of life. My colleagues at HealthTeamWorks® and I are sincerely grateful for the wonderful people with whom we have had the pleasure of working in 2016. Here’s to making great strides toward continuous performance improvement in delivery of health and healthcare in 2017!