Helping Clinicians Improve Care: The Transforming Clinical Practice Initiative (TCPI)

About the PCPCC Support & Alignment Network for Patient, Family & Community Engagement       

The Patient Centered Primary Care Collaborative Support and Alignment Network (SAN) supports Practice Transformation Networks and participating clinicians to implement effective programs for engaging patients, families, and communities to improve health. The PCPCC SAN is part of the Transforming Clinical Practice Initiative (TCPI), a nationwide program to help clinicians transform the way they practice. TCPI’s goals are to improve outcomes, reduce costs, and improve health care quality.

The TCPI is recruiting 140,000 clinicians to participate in practice transformation, and is encouraging each one to involve patients and families in a meaningful way. Person-centered care makes a difference: it makes patients and families feel more engaged, encourages them to participate as partners in self-management, and improves the patients’ experience of care. Person and family engagement is a critical strategy needed achieve TCPI goals. Our SAN offers training, technical assistance and coaching to help TCPI clinicians successfully engage individuals, families and communities in partnerships for health.

Collaborating to Advance Person and Family Engagment in TCPI

The PCPCC SAN provides customized technical assistance along with tools, training events, and evidence-based resources to support patients, families, and clinicians in making the transformation to meaningful person-centered care. Technical assistance provided to PTNs and practices directly align with TCPI’s Person and Family Engagement (PFE) Measures. In collaboration with our partner organizations, the PCPCC SAN will ensure clinicians meet their goals in person and family engagement by incorporating PFE measures in our training and materials.

Our partners: 

• The Institute for Patient- and Family-Centered Care (IPFCC): As a SAN partner, IPFCC has been integrally involved in identification of the TCPI PFE measures. IPFCC will provide hands on coaching, training, and technical assistance to help practices identify and adopt best practices in PFE. IPFCC also hosts the “PFCC.Connect", an online forum where clinicians, patients, and family advisors can ask questions and collaborate to improve best practices. 
   
• YMCA of the USA: The YMCA is implementing community-integrated health programs in TCPI communities by developing clinic-to-community linkages. The goal is to improve self-management of chronic conditions and engage people at the community level. The Y’s model helps clinicians implement a population health approach invaluable in the transition to alternative payment models.  

Improving Care Through Partnership with Patients, Families, and Communities

As a Support and Alignment Network (SAN) the PCPCC provides support to patient and family partners, along with practices and PTN's across the U.S. to promote more meaningful patient partnerships in quality improvement and community collaboration with care teams. By helping participating clinicians partner with patients and families, we will achieve TCPI's goals of improved care, better health, and reduced costs. 

The PCPCC SAN offers educational webinars on implementing person and family centered care strategies along with a SAN Resource Library that includes guides, targeted one pagers and other information for getting started.  PCPCC and its partner organizations work directly with PTNs and clinicians to design PFE improvement programs to meet local needs and capabilities; we provide one on one technical assistance services whenever possible.  This includes:

• Coaching calls with PFE subject matter experts
• Virtual trainings and webinars customized to meet PTN and clinicians’ specific needs
• On-site speaking or technical assistance (if available)
• Helping to establish peer support programs as a person and family engagement strategy
• Assisting clinicians to develop community partnerships with local YMCAs that promote TCPI goals and a transition to population health
• Supporting patient/family advisors through the IPFCC's PFCC.Connect, a discussion board open to patients and family members, clinicians, health care staff, and administrative leaders.

Stories of Successful Partnership
Share your stories of successful partnership with patients and families in care redesign through our web-based map. The map is as an educational tool that  helps connect practices across the country interested in learning from each other on how they are redesigning their care delivery systems to be more patient- and family-centered through these partnerships. Submit the story of your successful patient and family engagement program here! 

For more information on the PCPCC SAN, contact Merilyn Francis, RN, MPP, Project Director 

The PCPCC Support and Alignment Network is supported Cooperative Agreement 1L1CMS331478 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.