Limited Market Test: Our Initial Replication Effort
Before we begin spreading and scaling a model of high-performance primary care, we had to first determine whether or not the model could be replicated. We called this initial replication effort a Limited Market Test (LMT), the objectives of which were to:
- Test the replicability of the model that has shown to improve quality and lower costs.
- Catalogue how practices transform and refine a curriculum (an evidence-based set of processes and tools designed by the Center to guide the implementation of these features).
- Develop a set of measures that can be used by practices to track progress.
As part of this effort, we teamed 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 developed a set of operating principles for the LMT that guided its design:
Design, Test and Validate For the Next Phase of Scale
During the LMT, health systems associated with the practices participated in the refinement of the curriculum and advised as to when the content was sufficiently refined for them to use in the next phase of scale. Patients and family caregivers were also involved to ensure a patient-centered approach was integrated into the content.
Integrate Improvement Process With Content to Accelerate Uptake and Smoothen Transformation
The engagement and facilitated implementation processes along with the content provided 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 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 how the LMT sites transformed has enriched our curriculum 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 curriculum 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 curriculum can be deployed through software to facilitate the implementation process at scale while retaining fidelity to the evidence-based model.
The Center determined that the LMT practices achieved enough replication to warrant investment in further prototyping. The next step will be to determine whether the implementation design can be refined to help practices, practice facilitators and health systems adopt the model more effectively and efficiently.
The LMT sites will continue as learning labs and testing sites to continue refinement of the curriculum and software so we can ensure change is not only transformational, but also sustainable.