Practice Facilitation: A Promising Option for Sustainability
In 2015, the Southeast Alabama Area Health Education Center (SEAAHEC) entered into an agreement with the University of Alabama, Birmingham Department of Preventative Medicine as a subcontractor in a research study: The Triple Threat. The program is a function of the Southeastern Collaboration to Improve Blood Pressure Control in low-income, minority patients who suffer from hypertension and live in the regional Black-Belt counties of Alabama and North Carolina. The University of North Carolina and East Carolina University are also principle partners in the five-year study.
The overarching goal of the research is 1) to provide guidance for primary care practices as they educate patients in self-management of their hypertension: to improve blood pressure levels and 2) to “compare the effectiveness of two practical approaches to achieving better control using practice facilitators (PFs) and peer coaches.” (Southeastern Collaboration to Improve Blood Pressure Control, 2017)
Practice facilitators are trained, certified professionals who assist clinical sites to implement best practices and evidence-based guidelines for blood-pressure control (Southeastern Collaboration to Improve Blood Pressure Control, 2017). Peer coaches provide objective support and accountability (Thorn, McLeod, Goldsmith, Peer Coaching Overview, 2007) and are most often lay persons who may serve as civic organizers and opinion leaders in their communities.
Both techniques are used in this study to measure effectiveness among rural, low-income African Americans who live in Black Belt counties in both Alabama and North Carolina. According to the study, minority, low-income, rural populations have a prevalence or triple threat for high blood pressure that may lead to strokes, heart failure, heart attacks, vision loss and kidney disease / failure.
In the early stages of research, team members canvassed the study region to identify and recruit 80 potential practice sites to participate in the study. Practices who join the program are provided cash incentives based on length of time participating in the study and any follow up with patients who will receive home blood pressure monitors. Additional benefits include:
Guidance and resources to enhance population health and support for patients with hypertension;
a computer workstation;
and a web-based patient education program for all patients seen by the practice.
(Collaboration to Improve Blood Pressure Control, 2017)
After the conclusion of the five-year study, the future role of practice facilitation as a business revenue stream for SEAAHEC is promising - but yet to be determined. According to Practice Facilitator Macie Craft who is contracted through SEAAHEC to support the Triple Threat study, the four key benefits of PF in primary care clinics include: standardization of patient care processes; meaningful use of Electronic Health Records; facilitating a team-based care environment; and educating staff on the importance of patient disease self-management.
Craft suggests that regional Area Health Education Centers in Alabama consider the long-standing North Carolina AHEC model. These Centers offer practice facilitation services, as one method, to attract additional funded studies – often leading to long-term contracts with practice sites.
This is a promising income option for the Alabama Statewide AHEC Program as Centers move through the fully funded, six-year Infrastructure and Development phase of federal support from the Health Resources Services Administration (HRSA). After the initial six years of full support, Centers enter a diminished funding cycle or Point of Service and Maintenance Phase with HRSA which can last indefinitely - requiring Centers to seek a sustainable income stream from outside contracts or alternate grant funding.
As the SEAAHEC staff and board work toward sustainability in Fall 2019, PF may be a viable option. Depending on the outcome of the Triple Threat study, the Center may be eligible to seek status as a Medicaid/Medicaid provider in order to receive reimbursement for assisting clinical sites who request the assistance of PF to help meet new guidelines with the Centers for Medicare & Medicaid.
SEAAHEC Practice Facilitator Macie Craft is pictured third from
the left along with Practice Facilitator and Healthcare Consultant
Liza Nicholson, and North Carolina staff members Monique
Mackey, Vice President-Area L AHEC Practice Support, and UNC
Nurse Consultant Jennifer Rees