Illinois AFP Focused on Helping Small Practices Meet Challenges of Health Care Reform

As family physicians everywhere struggle to adjust to a revamped health care system, the Illinois AFP has concluded that health care reform offers an opportunity to work with its members to meet and even exceed expectations of the new system. The chapter recently rolled out a four-part initiative called the Practice Improvement Network (2-page PDF; About PDFs) to educate its members about the various principles in the health care reform bill and help them transform their practices.

"In 2009, we were all about advocacy at the federal level, and in 2010, we held a patient-centered medical home (PCMH) conference as a way to find out what we, as a chapter, could do to help our members," says Vince Keenan, EVP of the Illinois AFP. "In 2011, we started an initiative to translate what is going on with health care reform at the federal and state levels into bite-sized nuggets that our members can use in their practices."

The four-part initiative consists of

The entire project is funded for a two-year period thanks to a $250,000 commitment from the Illinois AFP. According to Keenan, it is mostly geared toward solo and small FP practices because those practices need the most assistance to transform. In many instances, they don't have the staff and the resources of larger practices or corporate-owned practice sites, Keenan says.

As part of the initiative's first component -- communications -- the Illinois AFP used its website and a variety of chapter publications to help explain changes occurring because of the federal health care reform law and how the Practice Improvement Network could help FPs navigate those changes.

"We wanted to provide tools specifically for family physicians to excel during the transformation of the health care system," says Keenan.

The second component -- the ambassador program -- is a mentoring project that gives practices with little or no experience in practice transformation access to family physicians who are well versed in that transformation process.

"The ambassadors are people who have thus far walked the walk on practice transformation," says family physician Donald Lurye, M.D., CEO of a multispecialty group in Elmhurst, Ill., who serves as one of the ambassadors for the Practice Improvement Network.

The ambassadors will mentor family physicians on the various changes occurring as a result of health care reform, focusing on health information exchanges, chronic disease management and accountable care organizations. But, they also will provide overall assistance to practices, says Keenan.

The Illinois AFP also plans to establish five to 10 CME sites around the state to give family physicians greater access to relevant CME programs and to provide them with a place to gather and develop strategies to manage the various changes taking place in medicine.

The first three components of the Practice Improvement Network are open to all Illinois AFP members, but the fourth piece of the initiative -- the small-practice pilot program -- involves only 30 small practices in the state. It is designed to provide services and assistance to small practices (i.e., those with eight or fewer physicians in the practice) who want to transform into medical homes; at least one of the physicians needs to be a member of the Illinois AFP.

Practices in the program are required to invest $2,500 of their own money to participate each year. The Illinois AFP matches that amount, resulting in a total investment of $5,000 each year for each participating practice.

Thus far, the Illinois AFP has enrolled 17 practices, according to Helen Kate Liebelt, a project manager for the Practice Improvement Network. "Recruitment began in the early summer months and continues to ramp up as fall draws near," says Liebelt.

As part of the small-practice pilot, the chapter has contracted with established practice management coaches to work with participating practices on transforming themselves. These coaches will serve as linchpins for the project by conducting practice assessments and helping physicians in areas that need improvement. The AAFP's TransforMED program also is available to physicians in the pilot who prefer a self-study approach rather than working face-to-face with a coach.

Participating practices are not required to become recognized medical homes, and they can choose the clinical and practice management projects they want to work on and how fast they want to change their practices. "This pilot is not supposed to add extra burdens for any practice," Keenan says. "But it is supposed to help practices transform the way they want to."

Family physician Rachel Winters, M.D., operates a rural solo practice in Lawrenceville, Ill. She is typical of the type of family physician participating in the small-practice pilot project. Like many of her colleagues, Winters is apprehensive about the changes taking place because of the drive toward health care reform.

"I felt as a solo doctor, I had a high chance of just being left out to dry without having a way of keeping up," she says. That was one of the key reasons why she joined the Practice Improvement Network and the small-practice pilot project, in particular.

"Things are not financially good in my practice, and I need someone to help me review (my finances)," says Winters.

She also expects the coach to help her meet the federal government's meaningful use criteria for using electronic health records. "I think I am going to have a coach who has more experience with meaningful use than I have, which is virtually none at this point," says Winters. "I have taken steps to fulfill some of the meaningful use criteria, but the coach will take a look at what I am doing and will tell me if I am on the right track or not."

Winters also wants her practice to become a recognized PCMH. She notes that this likely will help her stay ahead of the curve and remain viable. She acknowledges, however, that she gritted her teeth when paying the $2,500 to participate in the pilot project. "As I said, finances are not great in my practice," Winters says. "But I anticipate the rewards will be greater than the expense."

In time, Winters expects that she will have a more efficient practice as a consequence of the Practice Improvement Network and the small-practice pilot. This "will benefit both me and my patients," she says.

Family physician Deborah Winiger, M.D., of Vernon Hills, Ill., a northern suburb of Chicago, also operates a solo practice, and she, too, is participating in the Illinois AFP small-practice pilot project. Like Winters, Winiger is concerned that health care reform will sweep her practice away. She is fighting back by actively seeking medical home recognition, something she has been trying to accomplish for the past several years.

Winiger identifies time as the biggest impediment to achieving PCMH recognition. "It is hard to find the time to do it all," she says, "especially when you are a solo doctor, and you do most things yourself."

She expects the practice coach will help her become a medical home. "I really want a person who can help look at my practice and make it better. I am a solo practitioner trying to stay solo and be independent, which is difficult in this world," says Winiger.

The $2,500 initial investment in the small-practice pilot led to some hesitation on Winiger's part. "But over the long term, I felt it was a reasonable investment," she says. "The Illinois chapter is actually matching our funds, so we get double what we have put in."

By becoming a recognized medical home, Winiger eventually expects to earn more money. She notes that public and private payers are likely to pay more to PCMH practices and says that becoming a recognized medical home will better position her in the future.

Although the Practice Improvement Network has just gotten under way, it already has provided some useful lessons other AAFP chapters can emulate, according to Keenan.

"We need to provide our members with the family physician viewpoint on health care reform," he says. "They need to know we are working for them and with them in this journey. That is probably the No. 1 thing that every chapter can do.

"Beyond that, I think every chapter needs to take a look at their marketplace and their members and figure out what is the best way they can go about helping their members take advantage of all the changes that are going on within health care reform."