Two states and numerous family physician practices will join a national quality care demonstration project as a result of a recently awarded $2.5 million grant from the Robert Wood Johnson Foundation.
The grant will support Improving Performance in Practice, or IPIP, which is designed to demonstrate that primary care physicians can incorporate evidence-based care protocols into their everyday clinical care, measure the results of providing that care and share the information with their peers. Participating family physicians are expected to come out of the program ready to meet pay-for-performance requirements that are on the horizon in both public and private payment systems.
Practice Improvement Grant Opens Door to More Family Physicians
By Leslie Champlin
4/27/2007
The Robert Wood Johnson Foundation awarded the two-year grant to the American Board of Medical Specialties, or ABMS, Research and Education Foundation, which will distribute the funds to IPIP programs in Colorado and North Carolina -- the two states currently participating in the program -- and to two additional states that will be selected by the end of the summer, according to Sheldon Horowitz, M.D., principal investigator for IPIP and special advisor to the ABMS president.
IPIP was launched in 2005 when the ABMS Research and Education Foundation received an initial Robert Wood Johnson Foundation grant and established a national steering committee that includes representatives from the ABMS foundation, the AAFP and the American Academy of Pediatrics.
"Family medicine has been most aggressive in support in terms of communicating this project and engaging with us," said Marjie Harbrecht, M.D., medical and executive director of Colorado Clinical Guidelines Collaborative, or CCGC, which oversees Colorado's IPIP program. (PDF file: 2 pages / 96 KB. More about PDFs.) She pointed to the AAFP's leadership in preparing its members for pay-for-performance programs, implementation of electronic health records and practice redesign.
"AAFP has been such a leader in this arena," she said. "With the Future of Family Medicine (Project) and TransforMED, you've set the stage. So when IPIP came along, family physicians said, 'Wow, I can do this.' The work that is happening at the national level also means we're going to have an opportunity to learn from each other."
Moreover, the North Carolina and Colorado AFPs have been instrumental in establishing a statewide participant network, according to Norman Kahn, M.D., AAFP vice president for science and education and co-chair of the IPIP national steering committee. "In both North Carolina and Colorado, it was the state AFPs that took the lead," he said. "Family medicine has had a tremendous leadership role nationally and locally."
Harbrecht agreed. As a result of the Colorado AFP involvement, 15 family medicine practices are among the 26 IPIP practices there, she said.
IPIP was launched in 2005 when the ABMS Research and Education Foundation received an initial Robert Wood Johnson Foundation grant and established a national steering committee that includes representatives from the ABMS foundation, the AAFP and the American Academy of Pediatrics.
"Family medicine has been most aggressive in support in terms of communicating this project and engaging with us," said Marjie Harbrecht, M.D., medical and executive director of Colorado Clinical Guidelines Collaborative, or CCGC, which oversees Colorado's IPIP program. (PDF file: 2 pages / 96 KB. More about PDFs.) She pointed to the AAFP's leadership in preparing its members for pay-for-performance programs, implementation of electronic health records and practice redesign.
"AAFP has been such a leader in this arena," she said. "With the Future of Family Medicine (Project) and TransforMED, you've set the stage. So when IPIP came along, family physicians said, 'Wow, I can do this.' The work that is happening at the national level also means we're going to have an opportunity to learn from each other."
Moreover, the North Carolina and Colorado AFPs have been instrumental in establishing a statewide participant network, according to Norman Kahn, M.D., AAFP vice president for science and education and co-chair of the IPIP national steering committee. "In both North Carolina and Colorado, it was the state AFPs that took the lead," he said. "Family medicine has had a tremendous leadership role nationally and locally."
Harbrecht agreed. As a result of the Colorado AFP involvement, 15 family medicine practices are among the 26 IPIP practices there, she said.
Practice-specific Assistance
IPIP provides practice-specific tools -- including quality improvement coaches -- that enable family physicians to redesign their practices, incorporate evidence-based care protocols into their everyday clinical care, and then measure and report the results of providing that care.
"Our goal is to create a dramatic improvement in quality of care in primary care medicine," said FP Warren Newton, M.D., M.P.H., who oversees the IPIP project in North Carolina.
Participants get help with implementing disease registries, the chronic care model, population-based care management, workflow analysis, team building and communication, quality improvement principles, and open-access scheduling.
Both pilot states were selected because they have an existing infrastructure on which to build a statewide program. Colorado has the CCGC, and North Carolina has a collaboration between Community Care of North Carolina, or CCNC -- a system of 15 not-for-profit health networks that coordinate care for Medicaid patients among physicians, local health departments, hospitals, social service agencies and other community programs -- and the North Carolina Area Health Education Centers, or NC AHECs.
CCGC was established in 1996 to resolve the problem of having multiple clinical guidelines that disseminated conflicting requirements and confusing messages. The organization successfully developed and helped implement clinical guidelines for diabetes, depression, colorectal cancer screening and asthma, as well as for seven other clinical areas.
North Carolina's IPIP capitalizes on infrastructure built by NC AHEC and CCNC and includes the state's Division of Public Health, the North Carolina AFP and other primary care medical societies. To date, 13 of North Carolina's 18 IPIP participants are family medicine practices, and another 50 to 100 medical practices are expected to join in the next two years.
"There's a lot of enthusiasm from doctors for practice redesign," said Newton.
"Our goal is to create a dramatic improvement in quality of care in primary care medicine," said FP Warren Newton, M.D., M.P.H., who oversees the IPIP project in North Carolina.
Participants get help with implementing disease registries, the chronic care model, population-based care management, workflow analysis, team building and communication, quality improvement principles, and open-access scheduling.
Both pilot states were selected because they have an existing infrastructure on which to build a statewide program. Colorado has the CCGC, and North Carolina has a collaboration between Community Care of North Carolina, or CCNC -- a system of 15 not-for-profit health networks that coordinate care for Medicaid patients among physicians, local health departments, hospitals, social service agencies and other community programs -- and the North Carolina Area Health Education Centers, or NC AHECs.
CCGC was established in 1996 to resolve the problem of having multiple clinical guidelines that disseminated conflicting requirements and confusing messages. The organization successfully developed and helped implement clinical guidelines for diabetes, depression, colorectal cancer screening and asthma, as well as for seven other clinical areas.
North Carolina's IPIP capitalizes on infrastructure built by NC AHEC and CCNC and includes the state's Division of Public Health, the North Carolina AFP and other primary care medical societies. To date, 13 of North Carolina's 18 IPIP participants are family medicine practices, and another 50 to 100 medical practices are expected to join in the next two years.
"There's a lot of enthusiasm from doctors for practice redesign," said Newton.
IPIP's Benefits
Working under the philosophy that "you can't put chaos onto chaos and expect success," IPIP helps medical practices address their most vexing and time-consuming issues first, and then helps them with tools and processes to implement, measure and report clinical guidelines, said Harbrecht.
In doing so, the practices receive the training and tools -- such as registry software -- that will enable them to tackle the next practice redesign challenge.
"When they have success with solving their worst problems, they have confidence to apply practice redesign to other issues," said Harbrecht.
In return, participating physicians agree to establish an infrastructure to collect and report quality measures data and to implement disease registries.
"We are committed to the requirement that you need to be measuring your outcomes in order to redesign and improve," said Harbrecht. "We offer them services and support in exchange for their meeting the mandatory requirement that they put in place a multifunctional team reporting different aspects of care."
In addition to increasing the efficiency of their practices and establishing a system that will enable them to participate in what likely will be mandatory pay-for-performance programs, participating family physicians reap numerous other benefits. In both programs, physicians get
In doing so, the practices receive the training and tools -- such as registry software -- that will enable them to tackle the next practice redesign challenge.
"When they have success with solving their worst problems, they have confidence to apply practice redesign to other issues," said Harbrecht.
In return, participating physicians agree to establish an infrastructure to collect and report quality measures data and to implement disease registries.
"We are committed to the requirement that you need to be measuring your outcomes in order to redesign and improve," said Harbrecht. "We offer them services and support in exchange for their meeting the mandatory requirement that they put in place a multifunctional team reporting different aspects of care."
In addition to increasing the efficiency of their practices and establishing a system that will enable them to participate in what likely will be mandatory pay-for-performance programs, participating family physicians reap numerous other benefits. In both programs, physicians get
- regular training and guidance in office redesign and in implementing and measuring clinical guidelines from a quality improvement coach,
- credit toward American Board of Family Medicine maintenance of certification,
- 20 hours of CME credit, and
- shared information about successes and problem-solving that lets them avoid "reinventing the wheel."
Colorado family physicians also get a reduction in their medical liability insurance premiums, and in North Carolina, early participants get $2,000 to compensate them for additional administrative activities.
The biggest challenge in both states has been working with health information technology that lacks disease registries, said Harbrecht and Newton.
"The trouble is that many current EHRs don't have registries or don't provide population studies," said Newton. "But the technology is getting there."
The biggest challenge in both states has been working with health information technology that lacks disease registries, said Harbrecht and Newton.
"The trouble is that many current EHRs don't have registries or don't provide population studies," said Newton. "But the technology is getting there."
