The Primary Care Extension Program: A Catalyst for Change

Abstract

The Affordable Care Act authorized, but did not fund, the Primary Care Extension Program (PCEP). Much like the Cooperative Extension Program of the US Department of Agriculture sped the modernization of farming a century ago, the PCEP could speed the transformation of primary care. It could also help achieve other goals such as integrating primary care with public health and translating research into practice. The urgency of these goals and their importance to achieving the Triple Aim for health care should increase interest in rapidly building the PCEP, much as the need to feed the country did a century ago. 2013;11:173-178. doi:10.1370/afm.1495. Ann Fam Med INTRODUCTIONP assage of the Affordable Care Act of 2010 (ACA) laid a foundation for unprecedented support of primary care, placing it at the core of a learning health care system that seeks to achieve the Center for Medicare and Medicaid Services' Triple Aim: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.1 This article seeks to help clinical and policy leaders understand how critical the Primary Care Extension Program (PCEP) is to enhancing primary care effectiveness, to the integration of primary care and public health, and to translating research into practice, all with the goal of achieving the Triple Aim for health care. 2,3 Before the ACA, primary care leaders were already engaged in designing and testing new models of care, particularly the patient-centered medical home (PCMH). Evidence suggesting that these reformed models of primary care improve health outcomes while reducing costs has stimulated a surge of interest for widespread transformation of primary care. 4,5 Many of these high-performing models have increased capacity for monitoring and managing population health, and some have bridged the substantial gap between primary care and public health. 6,7 Despite early evidence and growing enthusiasm, primary care transformation has not yet arrived at a tipping point, and the United States lacks a mechanism for facilitating the change. PRIMARY CARE EXTENSION PROGRAMAnticipating these challenges to primary care transformation, the ACA authorized the Agency for Healthcare Research and Quality (AHRQ) to create a national the PCEP. This section of the law states that the principal charge of the PCEP is to "assist primary care providers to implement a patient-centered medical home to improve the accessibility, quality, and effi ciency of primary care services" through local deployment of community-based Health Extension Agents. In addition to their practice facilitation roles, these agents may "collaborate with local health departments, community health centers, tribes and tribal entities, and other community agencies to identify community health priorities and local health 7 This Institute of Medicine study specifi cally mentions the PCEP as an important model for developing these partnerships. Roots in the Department of Agriculture's Cooperative ExtensionThe PCEP builds upon...

Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions

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The Future of Family Medicine Version 2.0: Reflections from Pisacano Scholars

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Practice-based Research Networks at the Crossroads of Research Translation

“…However, another, somewhat different approach could also be proposed that would keep the scope of PBRN activities within the "experimental farm" through strategic linkages to the evolving Primary Care Health Extension Program (PCEP). 16 This approach could organizationally separate the generation and testing of evidence (a more scientific activity) from the diffusion of innovations emanating from PBRNs (a more structural or systemic activity).…”