The Importance of a Practice Facilitator in Practice Transformation: A Conversation with Boulder Valley Women's Health Center

Deciding to embark on a formal practice transformation journey is a critical decision for any practice, regardless of their characteristics or transformation history. Today we will define terms, identify types of opportunities, and ascertain key considerations to guide selection of a successful transformation partner. We will also learn from Boulder Valley Women’s Health Center as they embark on the practice transformation journey. Today we are learning from Cynthia Molina, Chief Executive Officer, as she shares her insights and perspectives on practice transformation.

Medical practices transforming their operations to a more patient-centered approach is not a new concept. The origins of Patient-Centered Medical Home (PCMH) trace back to the American Academy of Pediatrics in 1967. PCMH was the start. Through the years this model of primary care has been piloted, studied and has evolved. Moving beyond PCMH, Comprehensive Primary Care, Comprehensive Primary Care Plus (CPC+) and other advanced primary care models, have shifted to rewarding value over volume, sharing financial risk and emphasizing population management.

Currently, the Agency for Healthcare Research and Quality (AHRQ) defines the five core attributes of PCMH as:

• Patient-centered: The PCMH supports patients in learning to manage and organize their own care based on their preferences, and ensures that patients, families, and caregivers are fully included in the development of their care plans. It also encourages them to participate in quality improvement, research, and health policy efforts.
• Comprehensive: The PCMH offers whole-person care from a team of providers that is accountable for the patient’s physical and behavioral/mental health needs, including prevention and wellness, acute care, and chronic care.
• Coordinated: The PCMH ensures that care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services, and long-term care supports.
• Accessible: The PCMH delivers accessible services with shorter waiting times, enhanced in-person hours, 24/7 electronic or telephone access, and alternative methods of communication through health information technology (HIT).
• Committed to Quality and Safety: The PCMH demonstrates commitment to quality improvement and the use of data and health information technology (HIT) and other tools to assist patients and families in making informed decisions about their health.

HTW: Your professional experience is impressive and varied, some of which includes being a practice manager, a practice facilitator and currently a Chief Executive Officer. I imagine that experience gives you a unique perspective on practice transformation. I am curious what drove your decision to lead your teams through formal practice transformation now?

CM: COVID-19 is really our black swan moment. We were forced to quickly implement changes, if we are going to survive it’s critical to transform now.  

There is no one organization responsible for PCMH certification, a number of organizations provide voluntary regulation of PCMH accreditation or recognition. To pursue accreditation or recognition is separate from the decision to formally transform. Some additional insights to consider when making that decision may be found in this article from Medical Economics.

HTW: I understand that at this time you have decided not to pursue PCMH recognition. What contributed to your decision?

CM: We have fundamental work that needs to be completed before I would consider recognition. 

Numerous Practice Transformation opportunities are available from a number of potential projects or initiatives. These potential opportunities generally target reducing cost of care, improving outcomes, improving patient experience of care and improving provider and care team satisfaction. They may use different framework to achieve this work and include different deliverables but still focus operational changes that enhance practice performance in the five core attributes outlined by AHRQ. These opportunities can be administered by;

• Payer
• Grant or pilot projects
• Accountable Care Organization
• Consulting Group or Organization

The Primary Care Collaborative (PCC) provides a Primary Care Innovations and PCMH Map. This tool may help practices gain a larger perspective of the footprint of this type of work. 

HTW: How did you research opportunities for your practices and what influenced your decision to apply for the Innovation Support Project (ISP)?

CM: I received email communication about the program. When I did additional research, I discovered ISP, it’s a better fit for our organization right now.  

HTW: We’re very fortunate in Colorado, we have a long history of transformation. Many practices or team members have a connection to that history, they are aware of the right organizations or use the listserv option. I’ve also had practices do a Google search.  

In addition to HealthTeamWorks’ Practice Transformation facilitation support and resources, the following organizations offer additional information:

• Medical societies such as the American Academy of Pediatrics (AAP), American Medical Association (AMA), American Academy of Family Physicians (AAFP), and American College of Physicians (ACP)
• Collaborative organizations that support advanced primary care such as the Primary Care Collaborative (PCC)
• Research and improvement science organizations including; Agency for Health Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI)

HTW: Between your experience and easy access to numerous resources and toolkits why did you feel the need for individual practice facilitation support?

CM: Team members don’t have the time or training to implement them independently. Working with Practice Facilitator provides a neutral party to help navigate the process, teach tools, guide difficult conversations and provide accountability. 

HTW: As an outsider, being able to share what we see in other practices is really important. Not only best practices, lessons learned and resources but the bigger perspective; normalize things. Practices can be very isolated it helps to know you are not alone.

HTW: As we wind down our conversation, what advice would you give practice leaders as they select their path for practice transformation?

CM: Be open to the idea of practice transformation, especially the facilitation. Actually, allocating money and resources to the work. Practice Transformation is a form of “self-care” for the practice. “It’s like putting on the oxygen mask first, before helping others.” It’s important to involve leadership in the transformation process, they really need to be engaged.

HTW: Thank you for sharing your valuable perspectives. We look forward to learning more about your journey next month.

Practice Transformation is an ongoing process it’s never really complete. As a facilitator I’ve been honored to support and witness many in this journey. We continue to learn more about the impacts of this type of work, especially as it relates to alternative payment. Check out the link to our impacts page where you’ll find a sampling of HealthTeamWorks projects: https://www.healthteamworks.org/our-impact.