Practice (Transformation) Makes Perfect

Colorado’s safety net clinics have always provided health care for the state’s most vulnerable populations who might not find care elsewhere. But recently, practice transformations have been changing the way clinics care for their patients. 

This year for Safety Net Clinic Week, my colleague Jeff Bontrager and I went on a quest to better understand practice transformations and the clinics undertaking them. In interviews with clinicians and administrators, we kept hearing the same thing: “We fundamentally believe that these programs are improving quality of care for our patients.” But what exactly are practice transformation programs? And how are they helping?

“Practice transformation” is a broad term used to describe a number of different efforts underway to improve the quality of primary care and reduce costs. Transformation efforts range in size and scope. Some transformations are simple changes to improve data collection, while others involve integrating different types of care under one roof to improve access for patients.

Another type of practice transformation is team-based care. This approach involves pairing each patient with a team of clinical staff to ensure that their needs are met and their care is coordinated. And team-based care is changing how clinicians practice medicine. When we visited Doctors Care — a safety net clinic in south metro Denver — the staff gave us the run-down of what a clinician’s day looks like under the team-based system. 

First, clinicians meet with their medical assistants and other providers in a morning “huddle.” Here they make a game-plan for taking care of each individual patient. 
Next, medical assistants take vitals, give immunizations, and prepare the patients to be seen by the clinicians. At a central hub in the office, clinicians and medical assistants come together to coordinate and provide the best possible care for their patients. 

Depending on patients’ needs, they can be seen by a dental hygienist to get their teeth cleaned, a behavioral health specialist for an evaluation, or their primary care provider for a check-up. 

But safety net clinics are providing more than just clinical care for their patients. One thing that struck me about the safety net clinics I visited was the lengths that clinics go to in caring for their patients outside of the office. For instance, Rocky Mountain Youth Clinics provide families access to their food bank if they are struggling to put food on the table. Some clinics even have enrollment specialists that can help patients enroll in Medicaid, housing or food-stamp programs.

When implementing practice transformations, Colorado’s safety net clinics also face unique challenges due to the nature of the populations they serve. More often than not, these patients are uninsured or enrolled in Medicaid — now called Health First Colorado. Clinics do not receive the same level of reimbursement as privately insured patients. This means that safety net clinics have limited budgets and resources to commit to transformation efforts. 

Though they face a number of challenges in doing so, safety net clinics continue to implement practice transformations. The clinics believe in the goals and the benefits they have for their patients. For the full report on practice transformation in safety net clinics, check out the Colorado Health Institute’s issue brief and primer here.