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Post TCPI - What Happens Now?

  • Category: Uncategorised
  • Published: Tuesday, February 04 2020 10:56
  • Written by Super User
  • Hits: 767

In a previous life at the Vermont Program for Quality in Health Care (VPQHC), BR staff were heavily involved in the Transforming Clinical Practices Initiative (TCPI) from CMS.

Charged with implementing recruitment targets and working with recruited practices in Vermont as a part of the Northern New England Practice Transformation Network (NNEPTN) we took each practice through the pre-developed assessment methodology, figured out improvement plans and regularly assessed them to ascertain improvements. They eventually "graduated" from the program with the assumption they were now better prepared for life in an Advanced Alternative Payment Model (AAPM). There were many many nuances associated with this, but the essence was as I've described. 

The TCPI was a four year program, nationwide in scope impacting 144000 providers. It was funded to the tune of $800m, which paid for a substantial program involving thousands of staff in design and implementation. It concluded Sep 29th 2019. 

The TCPI methodology was designed by external consultants for the program. Based on a maturity matrix model, it ranked practices in 29 domains on a scale of 0-3 (22 for Specialty practices). As the practice worked on issues, the score for each domain would increase until eventually, each domain should be at level 3. At first glance, this was an elegant method of assessing and monitoring practices along their individual improvement journeys. Upon deeper scrutiny though, difficulties started to become apparent. 

A methodology such as this, designed to accommodate the variations in practice for thousands of practices nationwide in a myriad of specialties is almost impossible to create. As we started working with it, the definitions of practice state at each score level in each domain in particular caused severe difficulties, as they were open to significant interpretation which led to inconsistent scoring. Our staff worked on a translation matrix with our partners at University of New Hampshire (UNH), which was codified into an excel tool we termed the Practice Plan Tool (PPN). This was shared with the TCPI community under a UNH license, and was adopted by many partners across the TCPI network as their practice coaches struggled with the same issues. 

As the TCPI program progressed, other shortcomings of the initial methodology became apparent, especially when putting it into the context of a practice transformation. Most practices had little idea of how they wanted to improve on a long term basis, and the TCPI methodology was predicated on a short term thinking horizon. This surfaced issues with the construction of improvement strategies in each specific domain, as they were not aligned with a longer term strategy. 

Our staff designed a rapid transformation program we called the Transformation Acceleration Program (TAP) based on our Patient Centered Value Stream Analysis (VSA) and Problem Solving methodologies, and encompassing six domains in the TCPI transformation methodology - the six that would yield greatest impact from being realigned with a VSA. The impact was in two main areas:

  • An increase of at least two steps on each domain score
  • A quantifiable release of currently used capacity

We enrolled seven practices in the program, and achieved significant impacts in a rapid cycle of just a few weeks with each practice. Each practice achieved goal #1 by increasing domain score by at least two points. Average capacity gains from the cohort of practices ranged from 1 to 12%. In one case this represented a full FTE. 

As the TCPI program concluded in September 2019, the nationwide TCPI network expected a confutation of the work, utilizing the excellent national framework and relationships that had been developed in TCPI. CMS decided to take a different direction, and developed a new program for practice improvement largely based around central EMR integration and a very small amount of Continuous Improvement. It also placed funding challenges on the program which made ROI decisions difficult. 

Where does that leave us?

BR is uniquely positioned to offer post TCPI assistance to TCPI practices around the USA. Our experience and capabilities are second to none in taking the work of TCPI and expanding it into a full transformation program for each individual practice. We have the TAP program experience, and understand how that can best be applied to each practice to produce a true, quantifiable change in operations and alignment with a longer term strategy. We would love to discuss how this could work in your own practice, producing improvements in a cohesive manner by coaching and training your own staff in advanced techniques and your leadership in ways to truly change your organization to make best use of these new skills. Our Practice Coaching program is designed to seamlessly integrate with a TAP initiative, and has proven successful in multiple practices. 

If you feel your TCPI work didn't achieve the potential you were expecting, over and above the preparations for moving into an AAPM, please don't hesitate to get in touch for a no obligation discussion on how you could proceed and build on this investment you've already made into your practice. Contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. or (802) 870 3433. 

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