Colorado Beacon project: Primary care improvements through sharing and coaching

The Colorado Beacon Consortium made gains in quality improvement as physician practices adopted electronic health records and joined a health information exchange known as Quality Health Network (QHN), according to a case study published this month by The Commonwealth Fund.

The seven-country region on the Western slope of the Rocky Mountains is one of the most sparsely populated areas in the United States, where the common practice of local referrals makes information exchange seem more natural, the authors state.

The organization drew inspiration from the efficient, community-oriented health care system in Grand Junction, Colo., but created five independent "medical neighborhoods."

"The CBC's experience demonstrates the critical role of a "macrointegrator" that can bring stake­holders together for delivery system transformation in a community or region…it drew upon universal principles of collaboration, physician leadership, and community action to help empower each medical neighborhood to define its own approach using common tools and technology," the report states.

QHN and Rocky Mountain Health Plans worked together in providing that "macrointegrator" leadership. Smaller, rural communities may value a local, trusted community resource to support HIE adoption more than financial incentives to move toward efficient data sharing, the report notes. Up to 85 percent of physicians are now electronically connected to the HIE.

"The most frequently cited achievement of the learning collaborative was to instill an appreciation among physicians for the value of data feedback on improving the performance of their practices as they identified gaps in care and then sought ways to address them," the report says.

The quality improvement initiative included coaching and mentoring at physician practices, with staffs becoming enthusiastically committed to the gains they were seeing. Julie Schilz, head of the Colorado Beacon Consortium, in 2011 described the physician practices as "actually starting to be hungry for data".

Eight objective quality metrics backed up the perceived improvements, with gains of 17 percent to 75 percent for primary care practices that participated.

Rocky Mountain Health Plans' leaders credit the practice coaching and more timely electronic distribution of hospital discharge alerts through the HIE with the region achieving lower-than-expected rates of emergency department visits and hospital readmissions among Medicaid- insured patients.

Among the lessons learned were the importance of:

  • Identifying and engaging key stakeholders
  • Spending the time to find common ground
  • Physician leadership
  • Setting realistic expectations of the time required for planning and build-out
  • At the outset, agreeing on common quality indicators for tracking aggregate results

Last August, eight practices in the consortium were selected to participate in the Comprehensive Primary Care initiative, an effort by the Centers for Medicare & Medicaid Services to foster collaboration among private health plans, Medicare and Medicaid to support and strengthen primary care.

To learn more:
- find the case study (.pdf)