At a time when a shortage of primary care providers is threatening the accessibility and quality of care in the country, the Robert Wood Johnson Foundation (RWJF) is teaming with the Group Health Research Institute on a new national program designed to identify creative practices that make primary care more efficient and effective. The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project) will identify primary care practices that use health professionals and other staff in ways that maximize access to their services, so these workforce models can be replicated and adopted more widely.
With millions more Americans poised to enter the health system as the Affordable Care Act is implemented, the new program will identify changes in policy, workforce, culture, education and training related to primary care that can improve the way practices function. Its goal is to identify and then study up to 30 high-functioning primary care practices to learn about innovative staffing arrangements that maximize the contributions of health professionals and other staff.
Ed Wagner, MD, MPH, and Margaret Flinter, PhD, APRN, are co-directors of The Primary Care Team, and the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle will serve as its national program office. Wagner is director of the MacColl Center and Flinter, a family nurse practitioner by clinical background, is senior vice president and clinical director of the Community Health Center, Inc., a statewide Federally Qualified Health Center in Connecticut and director of its Weitzman Center for Innovation. She is an alumna of the RWJF Executive Nurse Fellows program.
“The Foundation’s mission is to improve health and health care, and we cannot succeed unless we address the shortage of primary care services,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group. “The nation will not be able to train new primary care providers quickly enough to meet the need, so part of the solution must be to use the workforce we have more effectively. This new program will identify ways to do that.”
“Improving the quality of primary care is a key objective of health care reform. Central to the improvement of primary care is the development of effective primary care teams,” Wagner said. "We are delighted that this project will allow us to study some of the nation’s finest primary care practices and spread their staffing innovations to others.”
“This project is particularly important because it recognizes that there is tremendous diversity in primary care settings across the country,” Flinter said, “from small private practices, to large health systems, to community health centers. We need all of these practices to perform at the highest level.”
A National Advisory Committee, chaired by Thomas S. Bodenheimer, MD, MPH, adjunct professor at the University of California, San Francisco, School of Medicine, will develop and apply the criteria for selecting the exemplary primary care practices, which will represent a variety of settings, practice configurations and locations. A research team will conduct site visits and then the sites will join together in a learning community to share best practices and to help distill their innovations into a toolkit that can be used by others.
In recent years, many primary care sites have described creative workforce models, but there is little information available about how their workforce changes have affected access, quality, value, and patient or provider experience. Thus, many of the new workforce models have not been widely adopted. The Primary Care Team: Learning from Effective Ambulatory Practices is designed to identify those that improve patient and practice outcomes, and share information so they can be replicated.
Initial RWJF funding will support The Primary Care Team through June 2014.