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Practice Transformation Networks Explained

This week, on MAG’s ongoing Top Docs Radio series, I hosted two experts in practice transformation networks (PTN’s).

The Transforming Clinical Practice Initiative (TCPI) is designed to help more than 150,000 U.S clinicians improve quality and reduce costs – keeping in mind that the Medicare is changing from a volume-based payment system to a quality-based payment system in the next several years. The four-year, $800 million TCPI initiative is being funded by the Center for Medicare & Medicaid Innovation.

It is aligned with the Affordable Care Act (ACA) and the Medicare Access and Reauthorization Act of 2015 (MACRA). The TCPI includes a network of 29 “practice transformation networks” (PTNs) that are designed to 1) improve health outcomes and 2) improve care coordination and 3) better engage patients and families and 4) improve patient, clinician and staff satisfaction and 5) reduce the overall cost of care. There is no cost for clinicians or practices to join a PTN. There are four PTNs that support clinicians in Georgia.

QualityImpact PTN

The QualityImpact PTN provides medical practices with meaningful support and resources to help them thrive in a value-based delivery environment. The QualityImpact PTN is a conduit and agent of CMS to work locally with physician groups and practices to assist them in preparation and readiness for alternative payment models. It provides services across the southeastern U.S. and beyond. It has already surpassed its enrollment target of 3,400 clinicians. Practices that enroll in the QualityImpact PTN receive a “comprehensive, transformation ‘package’ that includes: MDinsight – A sophisticated, EHR-integrated, population health management platform; Care Delivery Consulting – Process improvement facilitation enabling improved efficiency, quality, and proactive patient management; Clinical Quality Improvement – Expert-led guidance tailored to care gaps/opportunities.”

National Rural Accountable Care Consortium

NRACC has recruited more than 7,000 providers nationwide and is leading more than 876 practices through transformation from volume-based to value-based care payment models. TCPI will equip practices and clinics with the education and resources to establish the necessary population health framework and infrastructure at no cost to participating physicians while improving revenue through new billable wellness and prevention services. The following TCPI services are delivered to each practice location free for four years: Health Data Analytics Software offering a Quality Improvement Program, Risk Stratification, Annual Wellness Visit Tracking and Care Planning Program; Training & Development for Care Coordinators, Practice Managers, Billers and Coders; Implementation of a Billable Chronic Care Management program; 24/7 Nurse Advice Hotline; Patient Satisfaction Program with computer tablets for each practice; and PCMH readiness assessments every six months and training in Quarterly workshops.

Debra Simmons is the project director for the Consortium for Southeastern Hypertension Control’s (COSEHC)QualityImpact PTN. She also serves as COSEHC’s executive director. COSEHC is a non-profit professional health care organization that is based at the Wake Forest University School of Medicine in North Carolina. Debra has a long history in health care – serving in such roles as clinical nurse, department director, chief nursing officer, and quality improvement program director in both pediatric and adult hospital settings.

Kathy Whitmire is the regional vice president of the National Rural Accountable Care Consortium. Her responsibilities include physician recruitment and oversight of continuous quality improvement for the Transforming Clinical Practices Initiative (TCPI) in the Southeast. Kathy’s experience is in health care reimbursement and education. She served as the managing director of a rural hospital network of 65 hospitals and their affiliated clinics and practices in the Southeast for 15 years. She holds a degree in business administration and is a member of the American College of Healthcare Executives and the Georgia Chapter of the Healthcare Financial Management Association.