Transforming Clinical Practice Initiative Awards (TCPi) - Background

Since the passage of the Affordable Care Act, CMS has launched numerous programs and models to help health providers achieve large-scale transformation. Programs and models – such as the Hospital Value-Based Purchasing ProgramAccountable Care Organizations, and the Partnership for Patients initiative with Hospital Engagement Networks – are helping clinicians and hospitals move from volume-based practices towards value-based and patient-centered health care services.

These efforts have contributed to fewer unnecessary hospital readmissions, reductions in healthcare-associated infections and hospital-acquired conditions, as well as improvements in quality outcomes and cost efficiency. Thanks to efforts such as Partnership for Patients, there has also been a cumulative total of 1.3 million fewer hospital-acquired conditions in 2011, 2012, and 2013 relative to the number of hospital-acquired conditions that would have occurred if rates had remained steady at the 2010 level. Approximately 50,000 fewer patients died in the hospital as a result of the reduction in hospital-acquired conditions, and approximately $12 billion in health care costs were saved from 2010 to 2013.

To date, there have only been small-scale investments in a collaborative peer-based learning initiative. CMS estimates that about 185,000 clinicians currently participate in existing programs, models, and initiatives that facilitate practice transformation. This represents only 16 percent of the nation’s one million Medicare and Medicaid providers. While this is an increase over previous years, there is more work to be done.

The TCPI will support efforts among medical group practices, regional health care systems, regional extension centers, and national medical professional association networks. These efforts will help clinicians expand their quality improvement capacity, engage in greater peer-to-peer learning, and utilize health data to determine gaps and target intervention needs. The initiative has two major components.

  • 29 Practice Transformation Networks will provide technical assistance and peer- level support to assist clinicians in delivering care in a patient-centric and efficient manner. Examples include providing dedicated coaches to help practices better manage chronic diseases, supporting improved patient access to practitioners through e-mails and other information technology applications, and helping to advance improved access to remote and virtual care.

  • 10 Support and Alignment Networks will focus on such initiatives as creating a collaborative for emergency clinicians to address appropriate utilization of tests and procedures and forming collaboratives between psychiatry and primary care providers so patients can receive basic mental health care from their primary care providers.