The Practice Transformation Institute (PTI) has received funding from Blue Cross Blue Shield of Michigan to support the third year of the Mackinac Learning Collaborative (MLC-III). The theme of this year's Collaborative is "Why Not the Best? Improving Performance for Care Management". The aim of MLC-III is to transform how patients receive more efficient, effective and value-added care management from an empowered collaborative care team, which includes the patient.

In addition to 17 primary care practices who participated in MLC-II, two new practices have joined the Collaborative. The practices provide patient care across the Detroit metropolitan area in both urban and suburban settings. Four of the participating teams are associated with primary care residency training programs in family medicine, internal medicine, pediatrics and geriatric programs affiliated with Wayne State University. Practices are members of the Medical Network One (MNO) physician organization and/or the Beaumont Physician Organization (BPO).

Kevin M. Taylor, MD, MS, serves as Chair of MLC-III. Dr. Taylor has significant interest and experience in primary care practice transformation. In addition to being a practicing internist with St. Joseph Mercy Ann Arbor and Chief Medical Director for the St. Joseph Mercy Medical Group, he is the Assistant Medical Director of Michigan’s Primary Care Transformation (MiPCT) project. MiPCT is a three year demonstration grant funded by the Center for Medicare and Medicaid Services. Several of the MLC-III teams are participating in the demonstration project, which is designed to test and measure innovative new care coordination models for patient-centered practice transformation.

Dr. Taylor will provide subject matter expertise as an MLC-III faculty member. He will also engage the practice teams through site visits and interaction with the practice coaches and performance improvement experts provided to each practice team by PTI. Performance improvement support is being provided by Joann Gutowsky, MHA, CMQ, CSSBB and Maureen O’Flynn, MM, Lean DFSS with CJ Systems who also serve as MLC-III training faculty. Ten health care professionals with practice transformation experience have been selected as practice coaches to facilitate, mentor and provide tools and resources for the practices.

The MLC-III practice teams attended a Kickoff Workshop in November 2011. The Workshop helped teams to understand the competencies needed to build collaborative care teams. PTI will use the Collaborative Care Team Learning Model as a structure for the MLC-III curriculum design and practice team competency assessment. The unique Learning Model was developed by Jodie L. Root, MBA who serves as Director of MLC-III and is an independent consultant and senior fellow with the Collaborative Care Institute at the University of Minnesota. Four competency domains assess skills, knowledge, behavior and values in Transformation Leadership, Interprofessional Collaborative Care, Transformation Systems and Processes and Care Model Innovation.

During the course of the 9 month experiential learning program MLC-III teams will design, implement and measure projects in their practices that improve team competencies in the Care Model Innovation domain. They will develop strategies for population health management, care coordination and performance improvement using metrics that track and measure patient process and clinical outcomes. All participating practices will use a population registry for managing their patient data.

The first MLC-III Learning Session was held January 17-18, 2012. Attending practice teams participated in exercises that assisted them in developing improvement projects in the areas of: 

• Collaborative care team development
• High risk patient identification and stratification
• Integration of an RN care manager into their practice to provide care coordination and complex case management
• Management of care transitions between facilities and/or providers
• Patient activation for improving self-management skills
• Complex case management

MLC-III will provide practice teams the opportunity to network in order to share  their ideas and best practices. Teams will work on projects each month and attend two additional learning sessions in April and July 2012. An Outcomes Congress in September will feature the successes of the practices in their MLC-III transformation journey.