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Summit highlights clinical improvement successes

Jul. 25, 2019, 10:08 AM

 

by Jill Clendening

A primary care practice achieving a 65% reduction in opioid prescribing rates within four months. A new hydration campaign at one women’s health practice reducing emergency room (ER) visits by expectant mothers by 4.3%. A pediatric practice analyzing their patients’ past ER visits and taking steps to significantly reduce unnecessary visits.

These are just a few of the success stories shared at a recent MidSouth Practice Transformation Network (PTN): Vanderbilt Health Affiliated Network (VHAN) Summer Summit held in Nashville as the four-year Transforming Clinical Practice Initiative (TCPI) contract managed by Vanderbilt University Medical Center nears an end.

In 2015, VUMC received a $29 million award from the Centers for Medicare and Medicaid Services (CMS) to assist 4,500 clinicians in more than 110 practices in Tennessee, Mississippi, Kentucky and Arkansas participating in the MidSouth PTN in transforming their practices in ways that would improve the quality of patient care, reduce costs and improve health outcomes.

Russell Rothman, MD, MPP, speaks at last week’s MidSouth Practice Transformation Network (PTN): Vanderbilt Health Affiliated Network Summer Summit.
Russell Rothman, MD, MPP, speaks at last week’s MidSouth Practice Transformation Network (PTN): Vanderbilt Health Affiliated Network Summer Summit. (photo by Steve Green)

The MidSouth PTN, representing a partnership between VUMC, the network, Baptist Memorial Health Care, the Mississippi Affiliated Health Network and the Safety Net Consortium of Middle Tennessee, is one of 28 PTNs across the United States that collectively include 29,000 medical practices with 140,000 clinicians. More than 60 clinicians and facilitators of the MidSouth PTN gathered for the local summit to review and celebrate improvement made at their practices as a direct result of their efforts related to the initiative.

“At Vanderbilt, it’s long been our mission to try to improve care, not just in Nashville, but across the region, so this has been a great opportunity to demonstrate that we can partner with these practices and these communities to help make a real difference,” said Russell Rothman, MD, MPP, principal investigator of the Mid-South PTN and vice president for Population Health Research at VUMC.

“We’ve had a health care model in our country that has been focused on care at the point of delivery, such as waiting for the patient to come in and meet a provider at a clinic or at the hospital. We’re helping practices think about care more at the population level, and how they can more proactively reach out to patients and their families to take care of them.”

The TCPI has several primary aims including supporting clinical practices as they transition from a pay-for-volume model to a value-based practice; improving patient health outcomes; reducing unnecessary hospitalizations; reducing unnecessary testing and procedures; generating cost savings; and building evidence from successful strategies resulting from the program that can be scaled nationally.

Another key TCPI aim is transitioning two-thirds of the participating practices to an Alternative Payment Model as established by Congress in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This means that health care practices that convert from a fee-for-service structure to a value-based service structure can receive added incentive payments from Medicare and other payers for providing high-quality, cost-efficient care. Value-based health care is a delivery model in which medical providers are paid based on patients’ health outcomes rather than the pay-for-volume model in which providers are paid based on the amount of services they deliver.

Clinicians who were part of the MidSouth PTN were provided informatics tools, on-site training and facilitated community/stakeholder engagement to assist them in improving care to their communities. Many of the informatics tools used as part of the contract were developed at VUMC to enhance collection and management of clinical and patient-reported data, provide clinical decision support and share best practices. Clinics also received training on developing, implementing and measuring quality improvement initiatives.

C.J. Stimson, MD, JD, medical director of the Office of Episodes of Care with VUMC Population Health and a Vanderbilt Health urologic surgeon, was the keynote speaker at the summit, and he told attendees that despite mixed messages out of Washington, D.C., and contradictory media headlines, “value-based care is here to stay,” and “purchasers and patients will drive the value transformation.”

Robert Flemming, PhD, TCPI director for the CMS, attended the summit and congratulated MidSouth PTN participants, coaches and grant administrators for their many successes over the span of the grant. He added that their successes would provide the foundation for additional quality improvement efforts that would continue to transform and improve health care in the United States.

Building on the work of TCPI, a new Value Based Care University (VBCU) will begin in August, said MidSouth PTN Director of Operations, Kirkland Ahern-Jones, MAC, MBA. The program, which includes faculty from CMS, Vanderbilt University Owen Graduate School of Management, and VUMC will offer tracks for front-line staff (practice managers), clinicians and health care executives (including consultants).

“We are grateful that TCPI provided the funds and initial support to VBCU to start growing,” said Ahern-Jones. “In semesters to come, we are excited about the program including additional offerings such as in-person and online certificates for those beyond VUMC.”

For additional information on VBCU, contact midsouthptn@vumc.org.

The work of the MidSouth PTN was funded by the U.S. Department of Health and Human Services-Centers for Medicare and Medicaid Services’ Transforming Clinical Practice Initiative, under grant number 1CMS331549-03-00.

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