Maryland Primary Care Program – Care Transformation Organization (CTO)
Care Transformation Organization’s will be a key feature of the program and will provide support via care management personnel, infrastructure, and technical assistance. Providers are not required to contract with and receive services from CTOs, though the State expects many providers would benefit from the education and technical assistance tailored to their needs.
As shown in the driver diagram below, CTOs will provide services that are integral to meeting the care transformation requirements but do not require the personal professional services of a physician.
CTOs shall help practices with personnel and expertise to:
- Transform the delivery of primary care
- Meet utilization and quality metrics
- Align with the hospitals and improve care coordination
- Ensure appropriate connections with other providers
- Assess and assist practices to manage care
- Access non-traditional workforce to enhance care management
- Use data to control total cost of care
MSLLC Vision for CTO
Care Management Services & Community Care Services
Management Support Services
MSLLC Approach to Support Practices
MSLLC CTO (in collaboration with the partner practice) will conduct a practice assessment using our customized practice assessment (PA) tool to assess the practice’s level of transformation across the key primary care functions and drivers. If an assessment report already exists, we will review the baseline data to inform our assessment process.
Assessment report outlining practice’s key areas of improvement.
Practice Care Transformation Assessment Report (Notional)
Following the assessment, MSLLC CTO will develop a recommended practice-specific approach and roadmap for care transformation outlining people, processes, and technology – and integration/handoffs between the partner practice staff and MSLLC CTO staff.
Partner practice-approved care transformation support implementation plan
Sample Workflow showing handoffs
MSLLC CTO will provide care management resources to support partner practices. If other CTO services are requested that includes change management & process improvement, the MSLLC CTO will support with implementing tests of change using PSDA methodology. We will also apply lean six sigma and other quality improvement methodologies to improve workflow efficiency and reduce redundancies.
Care management staff, Documented workflows, Dashboard & Reports – showing care delivery metrics, and visibly improved care delivery processes.
Sample Care Delivery Dashboard
MSLLC CTO will work closely with our partner-practice to help maintain a culture of improvement to sustain successful change. We will participate in any required practice team huddles and review sessions. We will also provide weekly and monthly updates on care management (and other support) services to review care delivery standards; using actionable data.
Sustained efficient care delivery processes that results in partner practices meeting all MDPCP requirements.
The MDPCP model will be new to most of our practices; our goal is to keep things simple & uncomplicated. MSLLC-CTO understands that no two practice transformation implementation will be the same; as all practices have unique capabilities & opportunities for improvement.
We’ll meet partner practices where they are & work closely with them on their terms to facilitate innovative approaches that result in value-based care delivery.