September 22, 2016

Replicating high-performing healthcare delivery models across the U.S. begins in the practices, clinics, hospitals and communities in which we all live and work, where we give and receive care. It is through the daily interactions of physicians, clinicians, support staff, patients and families, and surrounding stakeholders on the ground that our system will come to deliver the care Americans deserve and can afford. We invite you to join us as we develop a methodical approach to replicating and scaling exemplary models of care. We are working on the ground and laying a foundation for the future, so we think it is fitting to call this blog “Groundwork.”

Our starting point is primary care and our journey began in partnership with Stanford University’s Clinical Excellence Research Center. Stanford’s team identified 10 distinguishing features of mainstream primary care practices in diverse communities that deliver high-quality care at a lower-than-average total cost. Exemplars were found in urban and rural contexts. They were working under a range of payment structures, from fee-for-service to value-based payment. Some were small independent practices, and some were part of large integrated systems.

What the exemplar practices had in common was that they organized their care delivery so physicians could have deeper relationships with their patients, expanded team responsibilities to widen the practice’s interaction with others in the healthcare system, and they invested in their care teams rather than physical assets.

Replicating and scaling this high-performance model is important because so much healthcare is directly or indirectly impacted by primary care decisions. Primary care, as the point of first contact with health services, facilitates entry to the rest of the healthcare system. If we can accelerate the adoption of these primary care features on a national scale, we will begin to see profound systemic change in U.S. healthcare—improved clinical outcomes, patient experience, and physician satisfaction, at a significantly lower cost.

Our first implementation effort is underway in three primary care practices in New York, Missouri and Minnesota. We expect this Limited Market Test (LMT) to result in not only three highly improved practices, but also a refined change package (an evidence-based set of processes and tools designed by the Center) that will guide others through the implementation process.

It is no surprise that the work of practice transformation is hard, but there are early promising signs at our three LMT sites that we believe can lead to more widescale practice transformation. Through “Groundwork” we will highlight the adaptive and technical challenges facing healthcare providers and their teams—what works and what doesn’t—and how we all have to adapt to succeed.

We will share this experience not only from our perspective but, more importantly, from those practitioners, support staff, system leadership and the group of experts we’ve assembled. We are inspired by the people with whom we are working, and by this opportunity. We hope that you will join us as we learn how to spread and scale higher quality care at a lower cost, from the ground up.