October 2017
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Background. Primary care practices are poorly understood complex systems. As we collaborates with them on their transformation to value-based patient-centered care, understanding these complexities is essential for implementing any changes. Aim. To develop a complexity-aware assessment framework for primary care practice optimization. Methodology. We developed and gradually revised a comprehensive assessment tool that includes the functional domains from the Patient-Centered Medical Home model of care. The tool is tailored to the specific goals of a practice optimization initiative. During an in-person visit, this tool serves as a guide for trained Evolent staff to semi-structurally interview practice leadership. Practice staff in their various roles are also observed. While other available assessment tools generate simple itemized readiness scores, we focus more on the interconnectedness of factors internal and external to the practices. Results. From 2014 to 2017, we assessed 35 practices in 7 US states. Each assessment generated unique results, however the assessment of a particular Ohio practice for an initiative targeting hypertension and diabetes care revealed many common characteristics of a complex adaptive system. These include obstacles in using Electronic Health Records for proactive care management due to functional limitations and lack of staff training, the difficulty in managing patients covered under various insurance plans, the evolving roles in a shared care team structure, and the unpredictable outcomes of patient outreach. Recommendations were shared with the practice during a follow-up visit and an action plan was developed to address these interconnected challenges. Conclusion. Evolent’s assessment revealed improvement opportunities in busy primary care practices facing complex clinical, technical, administrative and interpersonal challenges. Lessons learned will be useful for those in the process of value-based care transforming.