1. Transforming Clinical Practice Initiative (TCPI) An Overview Connie K
Transforming Clinical Practice Initiative (TCPI) An Overview Connie K. Ihde, Director of Programs & TCPI Arizona Health-e Connection November 17, 2015

2. National Health Care Waste & Inefficiency
Estimated $700 Billion of “Healthcare waste” annually
$ Billion in “Unwarranted use”
$ Billion in “Provider inefficiency and errors”
$25-50 Billion in “Lack of care coordination”
White Paper: “Where can $700 Billion in Waste be Cut Annually from the U.S. Healthcare System? Robert Kelley, CP, Healthcare Analytics Thomson Reuters October 2009

3. White Paper: “Where can $700 Billion in Waste be Cut Annually from the U.S. Healthcare System? Robert Kelley, CP, Healthcare Analytics Thomson Reuters October 2009

4. Better Care
Smarter Spending
Healthier Communities

5. TCPI National Goals

6. Overall Aims of TCPI

7. TCPI Focus Areas

8. TCPI Assistance Model Practice Transformation Networks (PTN)
- Group practices, health care systems, and others Serve as trusted partners to provide clinician practices with quality improvement expertise, best practices, coaching and assistance Prepare and begin clinical and operational practice transformation
Support and Alignment Networks (SANs) - Professional associations and others - Align their memberships, communication channels, continuing medical education credits and other work - Support the PTNs and clinician practices

9. PTN Award
Provides technical assistance & peer-level support to clinicians in delivering care in a patient-centric & efficient manner
Supports clinicians in identifying & engaging with national improvement leaders to implement and continuously refine their practices
Allows practices to become actively engaged in the transformation
Ensures collaboration among a broad community of practices that creates, promotes & sustains learning & improvement across the health care system

10. PTN Approach
Provide “boots on the ground” support to coach, mentor & assist clinicians in developing core competencies that assist them in moving through various phases of practice transformation
Able to collaboratively (with CMS) lead clinicians & their practices through the transformation process, achieve the initiative goals, & ensure that clinicians & their practices can maintain & sustain the activities

11. SAN Award
Provides a system of national & regional professional associations & public-private partnerships that are working in practice transformation efforts
Utilize existing & emerging tools (CME, core competency development, etc.)

12. SAN Approach
Engage eligible medical professional associations, specialty societies, and other organizations that are involved in aligning programs with the aims of the initiative
Generate evidence-based guidelines for clinical practice
Promote measurements for improvement
Support members and practices in work to reduce unnecessary testing & procedures
Incorporate safety & patient and family engagement

13. Five Phases of TCPI

14. Arizona Goals Goal 1: Transform the delivery of care
Objective 1: 2,500 primary and specialty care providers will participate in the Practice Innovation Institute (PII) by the end of fourth project year
Objective 2: 2,500 participating providers will achieve Phase 5 by fourth year – participation in a pay for value approach
Objective 3: By the end of the four year project period, 90% of participating providers will enroll in a value‐based payment program, as a result of PII’s leadership and active engagement with providers.

15. Arizona Goals Goal 2: Improve outcomes while decreasing costs
Objective 1: Achieve a 10% decrease in unnecessary testing/procedures and 12% decrease in hospital readmissions and hospitalizations
Objective 2: Achieve 10% improvements in well child visits, adolescent well care, pediatric dental visits, breast cancer screening and diabetes care

16. Project Roles Arizona Health-e Connection Lead Agency and Fiscal Agent
Recruit Provider and Practices
Enroll in Practice Innovation Institute
Enroll in The Network
Strengthen EHR Integration & Meaningful Use
Develop Population Registries
Data Collection & Reporting
CMS Point of Contact and data reporting entity

17. Project Roles Mercy Care Plan Individual Coaching on areas including:
Performance improvement
Population-based health improvement
Rapid cycle change methods
Financial and administrative efficiencies
Care management
Risk stratification

18. Project Roles Mercy Maricopa Integrated Care
Provides consultation in areas including:
Technical assistance and overall quality improvement training to contracted providers
Development of effective methods to provide integrated care
Integration of physical and behavioral health care

19. Alignment Medicaid/Medicare/CHIP Programs
Optimize integrated delivery of physical & behavioral health care services
State and Regional Initiatives
Program goals align with Arizona’s Health IT Roadmap 2.0
Provide resource and information on tools that support health care transformation, including new payment models
Create & Implement strategy for information sharing between behavioral & Physical health care providers
ADHS State Health Improvement Plan
Plan has broad pubic input, measurable goals, objective to improve quality of care and reduce costs

20. Recruitment Goals Total Number of Clinicians to be enrolled: 2,500
Primary Care Clinicians
1,775
Specialty Care Clinicians
725
Yearly Recruitment Goals:
Year 1: 2,300
Year 2: 175
Year 3: 25
Year 4: 0
Over recruit to account for attrition

21. Recruitment Targets
Small Practices, Rural Areas and Medically Underserved
Arizona Primary Care Office
Arizona Primary Care Association
Sliding-fee Scale Clinics
Behavioral Health Provider Agencies
Arizona Medical Association
Arizona Osteopathic Medical Association
University of Arizona Center for Rural Health
Phoenix Children’s Care Network
Arizona Association of Community Health Centers

22. Better Care
Smarter Spending
Healthier Communities

23. Questions?