At age 20, MacColl Center helps the nation scale up for health reform

When MacColl Center Director Michael Parchman, MD, MPH, met with fellow advisors to the Advanced Primary Care Demonstration Project in Chicago last July, he knew the challenge before them was big. Sponsored by the Centers for Medicare & Medicaid Services, the group is helping 500 federally qualified health centers across the U.S. become “level 3 patient-centered medical homes”—in preparation for the millions of previously uninsured Americans who will seek care in these “safety net” clinics.

“At one point, we just looked across the table and said, ‘My gosh, has anyone ever done health-system change at this magnitude before?’” he recalls. They knew others had introduced specific care models or changed protocols for treating certain diseases across large systems, he explained. But the work ahead—made necessary by provisions of the new federal health-reform law—involves transforming the entire scope of primary care practice in these federally funded clinics. It means shifting patients’ expectations, redesigning employees’ job responsibilities, processes, and workflows—even changing methods of reimbursement. “So we had to acknowledge that we are involved in something very, very big,” he said.

Fortunately, GHRI’s MacColl Center for Health Care Innovation—celebrating its 20th anniversary this month—brings a rich mix of capabilities and experience to the challenge. Over the years, MacColl investigators have been creating, developing, researching, and disseminating new models of care nationally—the Chronic Care Model being its most famous. The group also provides technical assistance to health care systems and individual practices, and education and training in the field of chronic illness care.

The MacColl Center’s niche is the ambulatory (outpatient) care environment. “Other organizations that do systems-improvement work focus on hospital care,” Dr. Parchman explains. “But MacColl moves upstream to the place where most care for chronic illness happens. We want to catch patients before they go over the waterfall and end up in the hospital where costs are significantly higher.”

MacColl has built a reputation for taking innovative new models of care to scale. For example, under the direction of Ed Wagner, MD, MPH, MacColl led a 10-year project that developed and introduced the Chronic Care Model to health care systems nationwide through the use of collaborative trainings. At the same time, Dr. Parchman—in his previous job as director of the Agency for Healthcare Research and Quality’s Practice-Based Research Network—was leading efforts to spread the Chronic Care Model to independent primary care practices through the use of trained coaches and facilitators. “We’ve been learning a tremendous amount about the science of changing complex systems like health care delivery sites to help them better serve patients’ needs,” he says.

Another distinguishing feature is the MacColl Center’s commitment to keep its work in the public domain, explains Brian Austin, the Center’s associate director. “We help organizations take steps to serve their distinct audiences, but we also try to find solutions that can be generalized so everybody can use the knowledge and tools we develop.”

Prime beneficiaries of MacColl’s work are the nation’s federally qualified health centers—the same safety net clinics now gearing up for massive expansion. Recognizing the opportunity “to do it right from the ground up,” the government is turning to organizations such as MacColl to provide technical assistance for establishing patient-centered medical homes and expanding its primary care workforce, Dr. Parchman explains.

The Group Health care delivery system benefits from MacColl’s work as well. For example, the MacColl team helps evaluate the medical home model within Group Health clinics, looking at its impact on cost, utilization, and quality of care. MacColl staff members also play a major role in Group Health’s Partnership for Innovation, a program that enables Group Health Foundation donors to fund pilot studies of innovative new ideas from Group Health providers.

Such work aligns with Group Health’s mission to bridge the gap between research and patient care. Says Dr. Parchman: “When people in our field keep both feet in the world of research, their studies often die in the journals that publish them without ever affecting clinical practice.”

At the MacColl Center and across Group Health Research Institute the aim is to make a real difference—improving quality, cost, access, and patient experience.

“We have a moral imperative to make a difference now,” says Dr. Parchman. “The country’s health care system is in crisis and can no longer wait.”

by Joan DeClaire