| New Mexico | North Carolina | Oklahoma | Pennsylvania | |
|---|---|---|---|---|
| Extension program structure | Community-based health extension agents located in regional offices coordinated by a core team at the university. | Expanding activities and overlap between statewide organizations. Structured learning collaboratives. | A State hub and county- level nonprofit entities (CHIOs) located throughout the State. | A collaborative model bringing together existing practice transformation support infrastructure coordinated by a multistakeholder team. Two regional learning collaboratives. |
| Practice engagement | Recruited and engaged 34 practices, assessing their needs and interests and linking them to resources of interest to them. | Participants of the Regional Learning Collaborative included 13 teams consisting of 3 to 5 clinical and QI leaders from CCNC networks across North Carolina. Nine practices participated in the Care Transitions Collaborative. | 111 physicians and 39 practices engaged in QI projects. | 111 physicians and 39 practices engaged in QI projects. |
| Role of practice facilitators | Health extension rural officers provided practice facilitation and coaching, helping practices to assess readiness for change and track progress. | NC AHEC and CCNC offered practice facilitation on performance improvement, advanced care planning, meaningful use, and achieving PCMH recognition. | Each AHEC hired one practice facilitator to help counties apply for CHIO certification and small QI grants, perform practice audits and feedback, survey patients, train staff, and coordinate QI initiatives. | PA SPREAD and many of its partners offer practice facilitators to assist practices in transforming into medical homes. |
| Stakeholder engagement examples | New Mexico developed a partnership between the Office of Community Health and the new UNM Health System, under which all university clinical practices and hospital facilities operate with a growing partnership with provider groups and community hospitals across the State. | Increased AHEC/CCNC collaboration. One region initiated a new QI collaborative. | The Oklahoma Primary Healthcare Extension System, made up of the CHIOs, received help from Oklahoma Primary Healthcare Improvement Cooperative, the State legislature, and University of Oklahoma resources. | The program's General Contractor Model formed the basis for the Transformation Support Center included in several large-scale funding proposals. |
| Population and community health efforts | Health extension rural officers link practices to community resources across different sectors to address underlying social determinants of health. They also help primary care providers understand and adapt to local culture. | Population management approach. Collaborators include local health departments and other community-based organizations. | CHIOs engage in the development of County Health Improvement Plans and strategic prioritization processes. | Key partners in public and community health outreach include the Pennsylvania AHEC and Department of Health. |
| Incentives and PCMH recognition | Participating Medicaid managed care organizations offered PCMH incentives; three small clinics requested technical assistance to apply for PCMH recognition. Program offered $1,000 for participation. | Medicaid offered PCMH incentives. PCMH recognition was not the focus of the collaboratives; however, participation in the collaboratives increased improvement in PCMH-related care processes. | PCMH recognition was not the focus of participating practices. However, efforts by certified CHIOs catalyzed group QI among local physicians and brought diverse funding for more comprehensive care. Program offered mini-grants to CHIOs for QI activities related to county health improvement objectives. |
Multipayer PCMH initiative included several health plans. Learning collaborative participants were eligible for continuing medical education and maintenance of certification credit. Several practices reported that participation in the program greatly facilitated their achievement of NCQA PCMH recognition, because they already had the required elements for recognition in place after participating in the PA SPREAD project. |
| Products | An IMPaCT program online toolkit (www.healthextensiontoolkit.org). Community health worker program serving high-risk enrollees in Medicaid managed care while helping New Mexico implement community health worker certification. These efforts provided a new employment opportunity while also meeting the workforce needs of low-resource primary care practices. | Regional Leadership Collaborative Curriculum, with sample forms, team guidelines, event agendas, and assignments for modification and replication. Care Transitions Change Package. | A practice facilitator course was developed in collaboration with Lyndee Knox, PhD, and Chet Fox, MD. It is being offered by the Millard Fillmore College at the State University of New York at Buffalo. | A facilitator training program was developed and is being spread across Pennsylvania by the AHECs. |
Table adapted from Heider F, Hanlon C, Hinkle L. Primary Care Extension Models in Lead IMPaCT States. Washington DC: National Academy for State Health Policy; 2014. https://www.statereforum.org/primary-care-extension-chart.
Abbreviations: AHEC = Area Health Education Center; CCNC = Community Care of North Carolina; CHIOs = County Health Improvement Organizations; IMPaCT = Infrastructure for Maintaining Primary Care Transformation; NC AHEC = North Carolina Area Health Education Center; NCQA = National Committee for Quality Assurance; PA SPREAD = Pennsylvania Spreading Primary Care Enhanced Delivery Infrastructure; PCMH = patient-centered medical home; QI = quality improvement; UNM = University of New Mexico.
