The Transforming Clinical Practice Initiative (TCPI) is designed to help small practices and clinicians achieve large-scale health transformation. The initiative is designed to support more than 140,000 clinician practices over four years duration in sharing, adapting and further developing their comprehensive quality improvement strategies. The TCPI is one part of a unique strategy advanced by the Affordable Care Act to strengthen the quality of patient care and manage health care expenditures, ultimately saving the taxpayer from substantial costs. This document describes the initiative in detail with the type of participants, eligibility and reporting requirements of the participants. Understanding the implementation of this initiative not only helps clinicians, but opens up a huge market for Healthcare IT companies offering the products and services like EHR implementation, Integration, EHR/ Data Migration, Implementation of HIE etc.

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Transforming Clinical Practice Initiative -
Path to Primary Care Transformation
30 September 2017 | Author: Madhuri Komanduri, Healthcare Consultant, CitiusTech
CitiusTech Thought
Leadership

2. 2
Objective
 The Transforming Clinical Practice Initiative (TCPI) is designed to help small practices and
clinicians achieve large-scale health transformation.
 The initiative is designed to support more than 140,000 clinician practices over four years
duration in sharing, adapting and further developing their comprehensive quality
improvement strategies.
 The TCPI is one part of a unique strategy advanced by the Affordable Care Act to strengthen
the quality of patient care and manage health care expenditures, ultimately saving the
taxpayer from substantial costs.
 This document describes the initiative in detail with the type of participants, eligibility and
reporting requirements of the participants.
 Understanding the implementation of this initiative not only helps clinicians, but opens up a
huge market for Healthcare IT companies offering the products and services like EHR
implementation, Integration, EHR/ Data Migration, Implementation of HIE etc.

3. 3
Agenda
 Introduction
 Goals and Drivers
 Collaborative Networks and Participants
 Five Phases of Transformation
 Technology Considerations
 Award Submission Requirements
 Reporting Requirements
 References

4. 4
Introduction
Eligibility:
 For the TCPI model, clinicians include primary care and specialty physicians, nurse practitioners,
physician assistants, clinical pharmacists, and their respective practices.
 Practices and/or family physicians participating in the following programs are not eligible to
receive technical assistance from the TCPI program:
• Medicare Shared Savings Program
• Pioneer ACO Program
• Next Generation ACO Model
• Multi-Payer Advanced Primary Care Practice
• Comprehensive Primary Care Plus
$840mn
Funds
assigned
for TCPI
Purpose:
 The Transforming Clinical Practice Initiative (TCPI) is one of the largest federal investments
uniquely designed to support clinician practices through nationwide, collaborative and peer-
based learning networks that facilitate large-scale practice transformation.

5. 5
TCPI Goals
 Generate savings for the federal government over a period of 4 years
as well as commercial payers
 Transition 75% of clinicians that complete the TCPI transformation to
participate in Alternative Payment Models
 Support more than 140,000 clinicians in work to achieve practice
transformation
 Improve health outcomes for 5 million Medicare, Medicaid and CHIP
beneficiaries
 Reduce unnecessary hospitalizations and overutilization of other
services for 5 million Medicare, Medicaid and CHIP beneficiaries
 Sustain efficient care delivery for Medicare, Medicaid and CHIP
beneficiaries
 Build the evidence based on practice transformation so
that effective solutions can be scaled

6. 6
TCPI Drivers
Primary Drivers Secondary Drivers
Patient and
Family Centered
Design
 Patient and Family Engagement
 Team-based relationships
 Population Management
 Practice as a community partner
 Coordinated care delivery
 Organized, evidence based care
 Enhanced Access
Continuous Data-
driven Quality
Improvement
 Engaged and committed leadership
 Quality Improvement strategy supporting a culture of quality and safety
 Transparent measurement and monitoring
 Optimal use of Healthcare Information Technology to dramatically lower costs in the
provision of quality health care
Sustainable
Business
Operations
 Strategic use of practice revenue
 Staff vitality and joy in work
 Capability to analyze and document value
 Efficiency of operation
These drivers together accelerate/effect achieving the aim of improving outcomes with reduced healthcare costs.

7. 7
TCPI Collaborative Networks
Support and Alignment Networks (SAN)
SANs utilize national and regional professional associations and public-private
partnerships to ensure sustainability of these efforts and support the recruitment of
clinician practices serving small, rural and medically underserved communities.
Practice Transformation Networks (PTN)
The Practice Transformation Networks are peer-based learning networks designed to
coach, mentor and assist clinicians in developing core competencies specific to
practice transformation.
Quality Improvement Organizations (QIN-QIO)
A Quality Improvement Organization (QIO) is a group of health quality experts,
clinicians and consumers organized to improve the quality of care delivered to people
with Medicare. CMS identifies the core functions of the QIO Program as:
 Improving quality of care for beneficiaries
 Protecting the integrity of the Medicare Trust Fund
 Protecting beneficiaries by expeditiously addressing individual complaints
TCPI initiative supports different types of collaborative networks formed by the wide variety of different
health care providers like – clinicians, pharmacists, nurse practitioners etc. working towards the
common goal of achieving sustainable practice transformation to provide better care to the patients.

8. 8
TCPI Participants
 The providers who want to lead the collaborative networks like PTN & SAN will receive cooperative funding
from CMS who have pre-existing relationships with multiple clinician practices (primary care and/or
specialists) that include data sharing capabilities.
 This funding is spent on the different types of participants whom these leaders would be supporting
technically and functionally through the transformation.
Participants of these networks can be any one of the following:
 Quality Innovation Network-Quality Improvement Organizations assess the clinician practices’ progress that
are part of PTN/SAN through five defined phases of practice transformation, by conducting TCPI baseline
assessments and ongoing follow-up assessments for each practice.
Practice Transformation Networks
• Health Systems
• State Organizations
• Regional Extension Centers
• Quality Improvement Organizations
• Primary Care and/or Specialty Care
Practices
• Small/Rural/Medically Underserved
Practices
Support and Alignment Network
• Medical Associations
• Professional Societies
• Foundations
• Patient and Consumer
Advocacy Organizations
• University Consortiums
29
Practice Transformation
Networks
10
Support and
Alignment Networks
14
Quality Improvement
Organizations

9. 9
Five Phases of Transformation
Steps described below will describe the five phases of Clinical Practice Transformation
As clinicians progress through the TCPI five Phases of Transformation, they will be better
positioned to meet and succeed under delivery system reform efforts.
Set Aims:
 Develop basic
capabilities
to achieve
the aims
Use data to drive
care:
 Reporting and
generate
improvements
using data
Achieve aims of:
 Lower costs
 Better care
 Better health
Achieve Benchmark
Status through:
 Merit-based
Incentive Payment
System (MIPS)
 Alternative Payment
Model (APM)
 Physician Focused
Payment Model
(PFPM)
Thrive as a Business
via Pay for Value
Approaches:
 Sustain efficient
care delivery
 Build evidence
based on practice
transformation so
effective solutions
can be scaled

10. 10
Technology Considerations
Conversion into electronic form
& ONC Certified EHR usage
Develop information exchange
processes and identify
Interoperability requirement
Encourage usage of Patient
Portals, Telemedicine and other
mobile health applications
Develop registries based on
population subsets
Expand data collection and
analysis
Establish a 360° view through
Longitudinal Patient Record
 Easy exchange and utilization of patient health information
that will enable providing the care team a handy and accurate
patient health information
 Usage of different mobile health applications will keep patient
updated about their own health and increase the patient
engagement and provide patients’ care anytime anywhere
with reduced healthcare costs
 Registries are powerful tools in observing course of diseases,
care patterns and provide evidence-based outcomes to help
measure and improve quality of care in real-world clinical
practice
 Establishing information exchange among the network
participants will allow healthcare providers to access and
securely share patient’s vital health information improving the
speed, quality, safety, coordination, and cost of patient care.
 With LPR, providers are given real-time visibility, which makes
proactive treatment possible and allows a new way for
providers to practice.
 Data collection and analysis helps physician take evidence-
based decisions, providing real-time alerts, predictive analytics
and many more.
 This again helps in achieving the aim of efficient care delivery.

11. 11
Technology Considerations
Easy exchange and utilization of patient health information: This can provide the care team a
handy and accurate patient health information.
Encourage usage of different mobile health applications: Will keep patient updated about their
own health and increase the patient engagement and provide patients’ care anytime anywhere
with reduced healthcare costs
Develop registries based on population subsets: Registries are powerful tools in observing
course of diseases, care patterns and provide evidence-based outcomes to help measure and
improve quality of care in real-world clinical practice
Develop information exchange processes and identify Interoperability requirements:
Establishing information exchange among the network participants will allow healthcare
providers to access and securely share patient’s vital health information improving the speed,
quality, safety, coordination, and cost of patient care.
Establish a 360° view through Longitudinal Patient Record: With LPR, providers are given real-
time visibility, which makes proactive treatment possible and allows a new way for providers to
practice.
Expand data collection and analysis: Data collection and analysis helps physician take evidence-
based decisions, providing real-time alerts, predictive analytics and many more. This again helps
in achieving the aim of efficient care delivery.

12. 12
Award Submission Requirements
Budget Narrative
The proposed budget should be carefully developed and consistent with the PTN/SAN requirements.
Overhead & administrative costs are reasonable, with funding focused on supporting the PTN/SAN effort.
PTN narrative should highlight:
 PTN Recruitment/Enrollment/ Value
 Clinician Transformation Goals
 Data Strategy
 Organizational Capacity & Project Management
Plan
 Clinician Enrollment & Progress Strategy
SAN narrative should highlight:
 Establish clear linkage of proposed work to
quantitative results on aims
 SAN achievement of milestones
 Data strategy
 Organizational capacity & project
management plan
Standard Forms to be Used for Submission
SF 424(Official application for Federal assistance), SF 424A(Budget information non-construction) , SF
424B(Assurances Non-construction program), SF LLL(Disclosure of Lobbying Activities).
TCPI Project Abstract Summary
One-page abstract should serve as a brief description of the proposed project and should include the goals
of the project, the total budget, and a description of how the funds will be used.
Project Narrative
The project narrative is expected to address how the applicant will carry out the design and planning work
required to meet/exceed the TCPI goals.

13. 13
Reporting Requirements (1/2)
Reporting Requirement PTN Awardees SAN Awardees
Progress Reports
Include how cooperative agreement funds were used, describe
project or model progress, and describe any barriers, delays, and
measurable outcomes in CMS format.
Project Monitoring
CMS will enlist a third-party entity to assist CMS in monitoring the
performance results and outcomes.
Evaluation
Core set of evaluation metrics in
addition to supplemental metrics
that address the variation among
participating practices
Core set of measures in addition
to a menu set of measures that
can allow for practice and/or
region-specific measures to
drive improvement on a local
level
Federal Financial Report
 Quarterly, All grantees must utilize the FFR to report cash
transaction data, expenditures and any program income
generated via Payment Management System (PMS).
 On an annual basis, grantees must provide a report to be
uploaded into Grant Solutions which includes their expenditures
and any program.

14. 14
Reporting Requirements (2/2)
Reporting Requirement PTN Awardees SAN Awardees
Transparency Act
Reporting Requirements
Grant and cooperative agreement recipients must report information
for each first-tier sub-award of $25,000 or more in Federal funds and
executive total compensation for the recipient’s and sub-recipient’s
five most highly compensated executives as outlined in Appendix A
to 2 CFR Part 170
Audit Requirements
Comply with the audit requirements of Office of Management and
Budget (OMB) Circular A-133.
Payment Management
Requirements
Submit a quarterly electronic SF 425 via the Payment Management
System.
 An applicant may propose additional metrics as applicable and appropriate that connect in direct
and measurable ways to improved patient outcomes, reduction in over-utilization and/or cost
savings and that the applicant commits to specific outcome and cost reduction achievements.
 This opportunity provides up to $10 million over the three years (2016 to 2019) to leverage
primary and specialist care transformation work and learning that will catalyze the adoption of
Alternative Payment Models at a very large scale, and with very low cost.

15. 15
Summary
 Transforming Clinical Practices Initiative leverages the success of existing programs and models
that prove effective in achieving the transformation and quality improvement.
 The TPN/SAN awardees will help the participants in implementing the proven healthcare models
like ACOs providing them the technical and consulting assistance required.
 This initiative aligns with the criteria of the healthcare models of Affordable Care Act:
• Promoting broad payment and practice reform in primary care and specialty care
• Promoting care coordination between providers of services and suppliers
• Establishing community-based health teams to support chronic care management
• Promoting improved quality and reduced cost by developing a collaborative of institutions
that support practice transformation

16. 16
References
 https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/
 https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-
items/2015-09-29.html
 http://www.aafp.org/practice-management/transformation/tcpi.html
 http://www.tcpisan.org/?page_id=322
 http://depts.washington.edu/uwmedptn/programs/support-alignment-networks/
 http://www.federalgrantswire.com/centers-for-medicare-and-medicaid-services-department-of-
health-and-human-services-federal-grants.html#.WUIY2GiGPIU
 https://vhan.com/providers/ptn/

17. 17
Thank You
Authors:
Madhuri Komanduri
Healthcare Consultant
thoughtleaders@citiustech.com
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