The Time Has Come for Practice Transformation: What You Need to Know

By Cindy Green
Emtiro Health Practice Optimization Manager

Over the last three years or so, a new buzz phrase has emerged in healthcare: Practice Transformation. Many healthcare organizations around the country have asked, “What exactly IS practice transformation and what does it mean at the practice level?” Practice transformation is the term used to describe the process of achieving the “Triple Aim” of medicine. “Triple Aim” is defined by the Institute for Health Care Improvement and includes three goals: better care, higher patient satisfaction, and lower cost. Providers across the country recognize that in order to remain fiscally healthy, they must transform their practices.

Providers need to take steps to understand what practice transformation realistically means to their practice and how their team might initiate a successful transformation. Effective primary care transformation requires all office staff to adopt a new mind frame: one that focuses on process improvement and workflow design. The ultimate goals of the transformation are to increase practice productivity and quality by improving workflow efficiencies and focusing on clinical outcomes. The Centers of Medicare and Medicaid Services (CMS) designed the Transforming Clinical Practice Initiative (TCPI) to help practices understand how to create a clear vision and goals to achieve sustainable transformation.

Source: CMS TCPI PTN Information Webinar 2014

Source: CMS TCPI PTN Information Webinar 2014

The initial steps are focused on gaining a basic understanding of the change concept of transformation.  A key point is for practices to acknowledge that it’s not going to be “business as usual” and that changes have to be made. Knowing where to start with transformation begins with completing a readiness assessment that accurately measures the current state. A thorough assessment must include aspects of the practice’s daily functions in all areas, from clinical providers to office staff. The assessment should cover change concepts, including improvement, in four areas:

  1. Patient and family engagement:

  2. Clinical quality performance;

  3. Access to, and continuity of, care; and,

  4. Sustainable business practices.

Next, the practice will need to develop a shared vision and a detailed plan that addresses the goals of transformation, including specific clinical outcomes and utilization aims. Leadership buy-in is essential for transformation success.

Once there is full support from leadership, the practice must designate and empower a team to lead the transformation project. Staff will have to “unlearn” old habits and adopt new skills in order for transformation to be successful. Leadership will need to acknowledge that change is stressful and that staff may feel out of their comfort zone for a while. While change is not easy, many positive lessons can be learned along the way.

Practice leadership, as well as project team members, will need to encourage and reassure staff that getting on board with this change will ultimately increase the value of their contributions to the practice. The entire practice will need to have a common vision and understanding of the following questions:

  • What are we really trying to accomplish?

  • What do we want to be known for?

  • What are our goals regarding patient care, efficient workflows, team-based care, practice vitality, and a happy work environment?

  • What do we have to do to be successful as the practice transforms from rewarding volume to rewarding value?

Third, to progress through the stages of transformation, the project team will need to develop an understanding of change management concepts and tactics. Below are some examples of each change concept and some useful tactics to accomplish successful transformation.

Finally, the project team and practice will need to assess and review progress regularly and update goals and timelines accordingly. Value-based care models are the future of healthcare and providers need to realize that now is the time to begin the transformation of their practices. While fee-for-service arrangements still exist, the evidence is overwhelming that within the next few years providers will have no choice but to live fully in the value-based payment arena, regardless of whether the payer is commercial, Medicare, or Medicaid.

If your practice is looking to move forward with practice transformation, Emtiro Health Provider Services can help by conducting an on-site Comprehensive Practice Assessment that highlights opportunities for you to succeed in a quality-driven, valued-based payment environment. Emtiro Health has a wealth of experience in optimizing practices and will help your practice develop an informed strategy including goals, milestones, objectives, and outcomes to improve workflows and reduce administrative burdens. Emtiro Health Provider Services offers the following provider-focused support services:

  • NC Medicaid Managed Care-Advanced Medical Home Advancement Support

  • Comprehensive Practice Assessment for Transformation to Value-based Delivery Models

  • Quality Improvement Coaching

  • Practice Workflow Enhancement

  • Revenue Maximization

  • PCMH/PCSP Provider Recognition Programs

  • Behavioral Health Collaborative Care and Integration Models

  • Clinical Pharmacy Integration Services

  • Data Analytics

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-Benjamin Franklin

Brea Neri