Numerous challenges arise, all of which create collaboration opportunities for HRSA and CDC working with state and local health departments, health centers, and professional organizations. These challenges involve creating the teams; developing team practice approaches that fulfill all requirements of the law with respect to team composition and the scope, depth, and range of activities, community support services, and performance reporting; and integrating public health and public health work into the team model. Primary care providers must be enlisted, collaborations must be developed, health information technology must be utilized, and practice performance must be measured. The most significant challenge may be developing sustainability models for Medicare and Medicaid that can be translated into private health insurance and across varying population demographics. At the same time, the potential to transform community primary care practice into a model that can better manage the highest-risk populations through partnerships between private professionals and public health departments and safety net providers is great.

Reshaping of the Workforce

In the context of system transformation, the ACA falls short in the area of workforce improvement. Yet while major workforce investments are absent in the law, there are some opportunities for reshaping the workforce that HRSA and CDC, working together, could exploit.

Primary Care Extension Program

The ACA authorizes the Agency for Healthcare Research and Quality (AHRQ) to establish the Primary Care Extension Program (PCEP). This program is modeled after the U.S. Department of Agriculture’s Cooperative Extension Program, which revolutionized farming over the last decade, speeding the translation of research to plow and bringing learning from innovative farms back to universities (Grumbach and Mold, 2009; Vastag, 2004). The PCEP can help speed the transformation of care based on best evidence, whether from research or from innovative practices. PCEP agents will establish relationships with practices, much as pharmaceutical representatives did during the last 50 years, but with a detailing function geared to incorporating evidence-based techniques, preventive medicine, health promotion, chronic disease management, and mental and behavioral health services into primary care practices. The goal is to facilitate adoption of the principles of the patient-centered medical home and population health management. AHRQ funded four existing state-based PCEP programs, three of which are required to help three additional states develop similar PCEP programs (the fourth also needs to be scalable to other states). Thus,



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