Primary care practices across the nation are actively engaging in Federally sponsored transformation initiatives to test models of care that improve health outcomes in their patient populations, including the State Innovation Model, the Transforming Clinical Practice Initiative, and Comprehensive Primary Care Plus among others. Practices are no longer pioneering transformation, they are partnering and collaborating as they move towards value-based care.
Each program comes with their own set of milestones, deliverables and complexities. While this might at first sound overwhelming, many of these programs provide practices a great deal of flexibility, promote alignment with the work that is already being done, and arranges peer learning opportunities.
In states like Colorado where over 300+ primary care practices are actively engaged in these programs, work around transformation has become the norm. Now Colorado is at the forefront of innovation embracing these three keys to success.
Each program contains requirements practices need to achieve to demonstrate adoption of the initiative framework. How practices attain this is up to the practice and based on the resources available and awarded within the initiative parameters. Programs offer various options to realize outcomes and the practice can choose to follow step-by step instructions or tailor their methods. A fully directive approach is avoided by each of the programs to allow for flexibility and individual achievement of aims. Success within the programs is being realized when practices can connect the requirements to their own individualized population and cultural needs and when this is recognized, supported and celebrated in each initiative.
“I have other competing priorities.”
“We aren’t getting paid to provide this kind of care.”
“I don’t have time to add one more thing to my plate.”
Stated this way or in a variety of other ways, practice facilitators are hearing challenges expressed frequently regarding change, but change is here to stay.
However, forcing practices to choose a certain path based on one program or one payer is quickly being alleviated. Increasingly, there is alignment with other initiatives and payers. Payers and initiatives nationwide recognize the burden placed on practices when they are pulled in multiple directions. Instead, a concerted effort has been established to align expectations, allowing practices to see a path of least resistance, and address needs of all patients regardless of their source of payment. When external pressures are aligned, quality improvement efforts can be consolidated, efficiencies are identified, and optimal care is provided leading toward the realization of quadruple aim impacts.
Social learning theories exist that demonstrate the impacts environment and behavior play in learning and adoption of change. Albert Bandura’s social learning theory states, “Behavior is learned from the environment through the process of observational learning” (Bandura, 1977). This theory can be applied to work directly with patients in healthcare settings, but is also especially important for practices new to transformation. Hearing the experiences of others that have already addressed a problem and either identifying solutions or failures and pitfalls to avoid can not only be comforting but can allow individuals within the practice to have the confidence to take risks and make changes themselves. Peer learning opportunities and connections are being made in these initiatives between practices both directly and indirectly. Practices are placing high value on these learning community networks, that are offered both in-person and virtually, and it is leading to opportunities for advancement at an accelerated pace.
Primary care practices are seeing the benefits of engaging in Federally sponsored initiatives despite at first glance feeling inundated with one more thing to do. The opportunities offered to collaborate with peers, align their work and meet their own individual needs is allowing for successful adoption of a refreshed approach to models of payment and care delivery.