Limited Market Test: Our Initial Replication Effort

Before we can begin spreading and scaling a model of high-performance primary care, we must first determine whether or not it can be replicated. We call this initial replication effort a Limited Market Test (LMT), the objectives of which are to:

  1. Test the replicability of the model that has shown to improve quality and lower costs.
  2. Catalogue how practices transform and refine a change package (an evidence-based set of processes and tools designed by the Center to guide the implementation of these features).
  3. Develop a set of measures that can be used by practices to track progress.

As part of this effort, we are teaming up with experts in practice improvement, systems engineering, change management, patient engagement and data analysis at the following primary care practices in order to help them adopt the features that have shown to deliver high-quality care at a lower-than-average total cost:

  • Mount Sinai Doctors - West 147th Street – New York, NY
  • Internal Medicine of St. Luke’s – Chesterfield, MO
  • Essentia Health-Moorhead Clinic – Moorhead, MN

With an eye towards scale, we’ve developed a set of operating principles for the LMT that are guiding its design:

Design, Test and Validate For the Next Phase of Scale

During the LMT, health systems associated with the practices will participate in the refinement of the change package and advise as to when the content is sufficiently refined for them to use in the next phase of scale. Patients and family caregivers will also be involved to ensure a patient-centered approach is integrated into the content.

Integrate Improvement Process With Content to Accelerate Uptake and Smoothen Transformation

The process and the content together provide the roadmap and the skeleton key to unlock a successful transformation effort, helping a practice identify its own pain points and opportunities, and to find the most efficient path to transformation based on its own priorities. We have already learned, for example, that some changes may precede others to create capacity for subsequent implementation, others contribute to multiple features, and help practice teams pinpoint where they have the most control to create quick wins. Learning more about how the LMT sites transform will enrich our change package for others.

Be Both Evidence-Based and Adaptive to the Local Conditions of a Practice

The Center’s primary care model is rooted in rigorous research and its change package is steeped in practice improvement science. We will closely manage how it evolves in the scale-up process to maintain integrity to the science and will endeavor to design sufficient flexibility to be responsive to the needs of the practices. As we deepen the integration between process and content, the change package can be deployed on a digital platform to facilitate the implementation process at scale while retaining fidelity to the evidence-based model.

The LMT sites will continue as learning labs and testing sites to continue refinement of the change package and digital platform so we can ensure change is not only transformational, but also sustainable.

Site Profile: Mount Sinai Doctors

Mount Sinai Doctors - West 147th Street in Harlem, N.Y., previously part of the St. Luke’s Roosevelt Health System, is one of three sister clinics that provide community health services to the West Harlem and Morningside Heights communities in Manhattan.

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Site Profile: Internal Medicine of St. Luke's

Located in Chesterfield, a western suburb of St. Louis, Internal Medicine of St. Luke’s is made up of four internal medicine physicians and a nurse practitioner.

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Site Profile: Essentia Health-Moorhead Clinic

The Moorhead Clinic is part of Essentia Health, an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho.

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Expert Faculty

Meet the experts who are guiding the Center and the three primary practices in the Limited Market Test.

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What Other Healthcare Leaders Are Saying

What other healthcare leaders are saying about the Center’s transformation effort in primary care.

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