The Peterson Center on Healthcare is launching an initiative to improve quality of care, patient satisfaction and reduce costs at three primary care practices across the country. The goal is to better understand how to transform practices and expand the model to other clinics around the nation. But unlike a similar effort by the CMS, Peterson's initiative does not seek to reform the way providers are paid.
The New York-based grantmaker was established by Pete Peterson, a founder of the Blackstone Group, a private-equity firm, and a former CEO of Lehman Bros.
“The (primary-care) system is broken,” said Julia Murphy, director of dissemination at the center and the head of the primary-care initiative. Because patients' healthcare experience generally starts with primary care, improving those practices could result in higher quality of care overall, she said.
The model builds off a previous study funded by the Peterson Center and conducted by researchers at Stanford University's Clinical Excellence Research Center that assessed thousands of primary-care practices to pinpoint the common features that make them successful. In that study, researchers analyzed 15,000 primary-care practices and identified 10 best-practice characteristics, including around-the-clock availability, encouraging patient feedback, and ensuring patients complete their prescribed treatment plans.
The center is working to help replicate those best practices at New York-based Mount Sinai Doctors Faculty Practice, Chesterfield, Mo.-based Internal Medicine of St. Luke's, and Moorhead, Minn.-based Essentia Health-Moorhead Clinic.
The participating clinics were chosen for their diversity in location and because they were on different starting points along the journey to high-quality care.
The best practices are implemented through 22 projects. The care delivery teams at each clinic are given a clear picture of what the best practice is, and the team then can determine how they can implement change to achieve results.
“For practices to be successful in transforming the way that they deliver care, we have to be helping them to achieve their goals,” said Murphy, who was also part of the original team of Stanford researchers.
The three clinics have all begun implementing the center's primary-care model and are showing progress in patient satisfaction, quality scores and work satisfaction for the care team, the Peterson Center said.
“The team surfaced its own goals and learned how to apply improvement methodologies to improve how they work,” Niyum Gandhi, chief population health officer at participating practice Mount Sinai Health System, said in the statement announcing the initiative. “We are already seeing benefits, including higher quality outcomes, more time spent between clinicians and patients, and more streamlined administration.”
The initiative is similar to the CMS' newest program to strengthen primary care. That initiative, Comprehensive Primary Care Plus (CPC+) places physician practices in risk-based agreements with the goal of improving health outcomes and reducing costs. The five-year program was announced in April and will begin in January. It builds off the CMS' previous primary-care improvement program that began in October 2012 and will run until the end of the year.
CPC+ could include up to 5,000 practices in 20 regions, and will have two tracks. In one, the CMS will pay a monthly fee for specific services in addition to the fee-for-service Medicare payments. In track two, the CMS will pay practices a monthly care-management fee, as well as reduced Medicare fee-for-service payments and up-front comprehensive primary-care payments for those services.
In both the CMS and Peterson Center programs, primary-care practices strive for specific performance targets. But the CMS program aims to change the way providers are paid.
“It's about getting dollars to primary-care practices to drive transformation,” said Martie Ross, principal with healthcare consulting firm Pershing Yoakley & Associates. Financial incentives are necessary for the sustainability of such a program because transforming physician practices often requires a great deal of financial resources. For example, these models require sophisticated health information technology and patient outreach activities.
The practices participating in the Peterson Center's program have received small grants to help the teams implement the model, but there's no incentive program, according to a center spokesman.
The Peterson Center program does, however, seem more hands-on with the primary-care practices involved, Ross said.
“I think what differs is the level of technical assistance that we're providing on the ground to these practices to support them to go through the transition, and the reason we're giving that technical assistance is because we really believe that we will learn by being in the field with them,” Murphy said, comparing the program to CPC+. “That will allow us to really create a model that does efficiently and effectively guide others through the transformation effort.”