TransforMED Leads Patient-Centered Medical Neighborhood Kickoff Learning Collaboratives with Health Care Organizations in Eight More U.S. Communities

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Patient-Centered Medical Home transformation efforts get under way for health systems and primary care practices in federal demonstration project to connect health care communities for better health, improved care at lower costs.

The Patient-Centered Medical Home, operating in a well coordinated and connected medical neighborhood, should go a long way toward eliminating the fragmentation and unnecessary costs that patients now experience.

Health care organizations in eight U.S. communities are beginning the transformation to a Patient-Centered Medical Neighborhood (PCMN) concept of care at kickoff learning collaboratives led by TransforMED, a nonprofit subsidiary of the American Academy of Family Physicians.

The eight organizations are the remainder of 15 health systems nationwide to initiate TransforMED training as part of the CMS Center for Medicare and Medicaid Innovation’s PCMN demonstration project. Organizations kicking off their training programs in February were:
•Via Christi Health, Wichita, Kan.
•Owensboro Medical Health System, Owensboro, Ky.
•Western Connecticut Health Network, Danbury, Conn.

March kickoff learning collaboratives have been conducted with:
•Marquette General Health, Marquette, Mich.
•North Shore Physicians Group, Salem, Mass.
•Orlando Health, Orlando, Fla.
•Avera Health of Sioux Falls, S.D.
•Novant Health, Winston-Salem, N.C.

TransforMED is a leader in Patient-Centered Medical Home (PCMH) transformation, and medical neighborhood development. TransforMED and its collaborative partners VHA Inc., a national network of not-for-profit health care organizations based in Irving, Texas, and Phytel, a health care IT company based in Dallas, will work to support health care providers in participating communities in the PCMN demonstration project’s quest for improved health outcomes, improved quality of care and reduced costs.

The PCMN concept connects primary care with other community-based health care providers to create a more efficient, coordinated health care delivery network that improves care at a lower cost. By building on proven methodologies and solutions, the PCMN strives to improve and strengthen collaborative relationships among primary care practices and other providers such as hospitals and specialists.

At each kickoff learning collaborative, TransforMED works with respective communities’ primary care practices to develop and implement a PCMH and PCMN training program for local practices. The program incorporates consistent learning and improvement resources that will enable practices in all markets to share resources, results and experiences that promote a rapid and rigorous pace of change.

Initial training collaboratives scheduled for February and March helped participants understand goals, key drivers and upcoming milestones in the three-year project, and described team roles, responsibilities and expectations. TransforMED training curriculum at the kickoff meeting guides development of provider-led care teams and planning for improved access to care.

"Patients expect and deserve care that is safe, reliable and efficient,” said Bruce Bagley, MD, FAAFP, interim president and CEO of TransforMED. “The Patient-Centered Medical Home, operating in a well coordinated and connected medical neighborhood, should go a long way toward eliminating the fragmentation and unnecessary costs that patients now experience."

Besides improved medical care and total savings of an estimated $49.5 million, a fundamental aim of the collaborative PCMN CMMI project is to enhance the health care workforce, noted Noelle King Whitlow, program director for PCMN at TransforMED. The kickoff learning collaboratives are an important first step for participating health care community and primary care practices, she explained:

“Starting with the new PCMH model of primary care built around patients and delivered by teams, we educate local program participants on the idea of the expanded PCMN that connects primary care to acute-care hospitals, specialists and community health resources, and that increasingly helps patients manage their care proactively.

“These on-site collaboratives are like a retreat for practices and health systems. Not only do they supply a learning opportunity in a collaborative environment; they set up an occasion that allows the entire range of providers in a community to get to know each other and share lessons learned.”


About TransforMED
The Leawood, Kan.-based TransforMED is a wholly-owned subsidiary of the American Academy of Family Physicians. Established in 2005, TransforMED provides ongoing consultation and support to physicians looking to transform their practices to a new model of care that is based on the concept of a Patient-Centered Medical Home. TransforMED is an active member of primary care communities and recognizes and supports the unique value that primary care offers to patients and the health care system. TransforMED shares and supports the idealism and altruism of primary care physicians and the strong commitment to their communities and patients through continuing patient relationships and independent decision making. TransforMED offers practices both products and services, including consultation and advice on implementing the patient centered medical home model. To learn more about TransforMED, visit Follow us on Twitter and find us on Facebook.

About VHA Inc.
Founded in 1977 and based in Irving, Texas, VHA Inc. is a national network of not-for-profit health care organizations that work together to drive maximum savings in the supply chain arena, set new levels of clinical performance, and identify and implement best practices to improve operational efficiency and clinical outcomes. VHA leverages its expertise in analytics, contracting, consulting and networks to help its members achieve their operational, clinical and financial objectives. In 2011, VHA delivered record savings and value of $1.9 billion to members. VHA serves more than 1,350 hospitals and more than 72,000 non-acute care providers nationwide, coordinating delivery of its programs and services through its 14 regional offices. VHA has been ranked as one of the best places to work in healthcare by Modern Healthcare since the publication introduced this list in 2008. For more information, visit and follow us on Twitter.

About Phytel
The premier company empowering physician-led population health improvement, Phytel provides physicians with proven technology to deliver timely, coordinated care to their patients. Phytel's state-of-the-art registry, which now encompasses more than 20 million patients nationwide, uses evidence-based chronic and preventive care protocols to identify and notify patients due for service, while tracking compliance and measuring quality and financial results. For more information, please visit Follow us on Twitter and find us on Facebook.

The project described is supported by Funding Opportunity Number CMS-1C1-12-0001 (the “FON”) from the Department of Health and Human Services (“HHS”), Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation (“CMS”). Pursuant to said FON, TransforMED and CMS have entered into a cooperative agreement to explore the development of new models for the delivery of better health, better health care and lower costs through improved quality for Medicare, Medicaid and Children’s Health Insurance Program (“CHIP”) enrollees. The project executed pursuant to the cooperative agreement shall not restrict the freedom of choice of providers/services for Medicare, Medicaid and/or CHIP patients in fee-for-service (“FFS”) plans. The project contents are solely the responsibility of TransforMED and its project affiliates, Phytel and VHA Inc., and do not necessarily represent the official views of HHS or any of its agencies.

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