1. Refining Practice Transformation Strategies LESSONS LEARNED FROM EXPERIENCED PRACTICES

2. Aimee Ducharme, Family Care Southwest Dr. Kelley Glancey, Byers Peak Family Medicine Beth King, Associates in Family Medicine PRESENTERS FACILITATOR - EMILIE BUSCAJ, HEALTHTEAMWORKS

3. Learning Objectives  Differentiate between federal sponsored programs: CPC Classic, CO-SIM, and ENSW  Describe multiple approaches to practice transformation in primary care with varied levels of resources  Apply strategies around how to identify milestone implementation gaps at the practice and develop a plan to improve  Explain the role of practice culture in transformation and how to address change fatigue across a multi-year program

4. Program Overview CPC Classic Program years (2012-2016) 5 comprehensive primary care functions (access and continuity, planned care, risk- stratification, patient engagement, and care coordination) eCQM, utilization and cost measurement Payer support Milestone and assessment tracking quarterly Colorado SIM Program years (2016-2019) 10 Building Block of High- Performing Primary Care with a focus on Behavioral Health Integration eCQM, utilization and cost measurement Payer support Milestone and assessment tracking 2x per year ENSW Program years (2016-2017) Advancing heart health in primary care eCQM – ABCS of cardiovascular prevention No payer support Milestone and assessment baseline and project completion

5. Practice Descriptions Family Care Southwest Number of practices: 1 Number of providers: 6 Active Patients: 6880 Location: Littleton, CO # of Care Managers: 1 Level of BH Integration: 5 Byers Peak Family Medicine Number of practices: 1 Number of providers: 2, 1 FTE Active Patients: 2231 Location: Winter Park, CO # of Care Managers: 0 Level of BH Integration: 4 Associates in Family Medicine Number of practices: 8 Number of providers: 55 Active Patients: 102,000 Location: Ft. Collins, CO # of Care Managers: 8 Level of BH Integration: 5

6. Approaches to Practice Transformation What is your quality improvement team structure? How was the decision made to form the QI team in this way? Why is this structure successful or isn’t successful? What have been your barriers and difficulties to practice transformation?

7. Improvement Plans What milestone gaps did you have prior to your engagement in CPC Classic? How did you identify these gaps? What was your process for filling these gaps? How do monitor and make sustained change? What have you used through lessons learned in CPC Classic that you are now doing differently in CO-SIM?

8. Practice and Community Culture How has your delivery of care changed since joining CPC Classic? What impacts did this project have on your practice/s culture? When joining this type of program what types of cultural issues should a practice expect? How would you minimize or maximize the impacts of a transformation program to practice culture?

9. If I were to start again from the beginning, I would change…

10. Questions