Black lives matter. As we witnessed the horrific murder of George Floyd and our nation's righteous outrage and sorrow, it's important to say this now and always without reservation or hesitation. Black lives matter. We need to say it, because in this time of pain and anguish, our neighbors, colleagues, patients, brothers, and sisters need to be heard. Black lives matter.

We also know that words are not enough. The United States has never truly reckoned with its 400 year history of racism and the racist systems that were built on slavery and the forceful takeover of native land. We see injustice today acutely through racist policing policies that disproportionately kill black men, women, and children and far too often fail to bring their families justice. Our history is also one of fighting for justice and that fight is not over.

As we confront the enormity of today’s challenges - a deadly pandemic, economic depression, and insecure housing on a massive scale - we must acknowledge that all of these issues are linked and exacerbated by systemic racism. Racism is a public health crisis, and nurses have always shown courage, conviction, and leadership in the midst of public health crises. From all of us at the National Nurse-Led Care Consortium, we stand with you.

In 2015, NNCC and the American Association of Nurse Practitioners (AANP) partnered to create the Nurse Practitioner Support & Alignment Network (NP SAN). The NP SAN was the only nurse-led SAN across the entire TCPI initiative. The NP SAN recruited over 7,700 clinicians into peer-based quality improvement networks on behalf of the TCPI. The NP SAN developed its own 18,000+ member network, drawn in part from NNCC & AANP’s network of over 250 nurse-managed health centers, 100,000+ clinicians (APRNs, RNs, BSNs) , and more than 11,000 FQHCs. These participants represented every U.S. state and the majority of the participants were full-time NPs working in an office practice or in-patient hospital setting.

The Transforming Clinical Practice Initiative

The Centers for Medicare and Medicaid Services (CMS) launched the Transforming Clinical Practice Initiative (TCPI) in 2015  to provide technical assistance to more than 140,000 clinicians (both primary and specialty care) over a four-year period in sharing, adapting, and further developing their comprehensive quality improvement strategies. TCPI created a nationwide, collaborative, and peer-based learning network designed to prepare practices to successfully participate in alternative payment methodologies (APMs). The primary goals of the TCPI were to:

The initiative provided support to over 160,000 clinicians in developing their comprehensive quality improvement strategies and entering APM models. TCPI improved health outcomes for 5 million people and generated $5 billion in savings. TCPI participants made significant progress in care coordination; engagement of patients and families in their care; and patient, clinician, and staff satisfaction. TCPI enrolled practices joined APMs at twice the national rate. The TCPI Change Package, with over 400 vetted resources, supported improvements in clinical outcomes, reductions in emergency room and medical resources utilization, and lowered costs for millions of patients.

The Nurse Practitioner Support & Alignment Network (NP SAN)

Through the TCPI, CMS funded Support and Alignment Networks (SANs) to provide a system for development of innovative quality improvement programs and workforce skills building through their existing and emerging tools, through utilization of professional associations and public-private partnerships. SANs supported the recruitment of clinician practices serving small, rural, and medically underserved communities to play an active role in the alignment of new learning.

Role of Nursing in Primary Care and Practice Transformation

Nurse Practitioners have been identified as a critical profession in the healthcare sector to meet the ever-increasing needs of the US healthcare system. In primary care, NPs are currently increasing workforce presence and also amplifying their role and scope as providers.

There are over 250,000 NPs in the United States with additional 25,000 new NPs moving into practice each year. 75% of these clinicians are primary care providers, delivering 1 million patient visits per year. 80% or more NPs are serving Medicare or Medicaid patients. Their roles include chronic disease management, working as part of a care team, and care coordination efforts. NPs and nursing professionals are critical to the delivery of transformed care, and the nursing sector can be a driver of high-performing practice transformation. NNCC is preparing nurses for that role.

Nursing has a critical role to play in practice transformation as they are often tasked to execute critical tasks associated with APM success. Nurse-led principles of care can be used to deliver improved outcomes for patients, staff, and the larger healthcare community. This includes:

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Supporting Practice Transformation from Nurse-Led Principles of Care

Through the NP SAN, NNCC supported NPs and other clinicians in their preparation for transition to value-based care.  The NP SAN disseminated trainings on the principles of nurse-led care, including interdisciplinary care team optimization and patient-centered care coordination.

Nurse-led Principles of Care Workshops

The NP SAN developed a series of workshops focused on critical principles of nurse-led care associated with practice transformation key to APM success, including the optimization of interdisciplinary care teams, and the use of care teams for care coordination. NNCC conducted 18 in-person training workshops for 962 participants from 216 practices across 13 states. More information about the workshop series can be found here. NNCC continues to deliver these workshops both in-person and via online platforms as part of several ongoing grant programs. Interested parties can inquire about these workshops by contacting Casey Alrich at .

SAFE Opioid Prescribing Series

To support NPs’ role in providing safe pain management in primary care in consideration of the increasing number of individuals with opioid use disorder, the NP SAN developed a safe prescribing training. The SAFE Opioid Prescribing Series: How to Safely and Effectively Treat Pain in Primary Care, is a six-part podcast module series with materials and references for download. Over 6,000 individuals completed the training, receiving over 10,000 CE hours. According to post-training surveys, at least 1,400 patients have been affected by the training; 71% of learners use information from the training for direct patient care; 44% are checking state PDMP regularly or more often as result of training; 51% improved opioid medication management; and 60% of learners are using individual care plans for opioid users. This training series is available for free to the public via AANP’s CE Center through March 20, 2020 here.

Webinar Lunch & Learn Series

Another series of trainings was the Lunch & Learn series that was developed to reach NPs at various levels of practice to provide support and increase knowledge base of practice transformation and the transition to value-based payment models. The webinar series was well attended with 10,870 unduplicated attendees over the duration of the series. In an evaluation of the series, participants rated the training content and identified how it prepared them to succeed under APMs.

Program Data

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Next Steps

With the TCPI grant concluded, NNCC will continue advocating for the voice of the NP and the role of nursing as a driver of practice transformation. NNCC continues to offer its nursing principles workshops, and is creating new workshop content focused on patient engagement, SDOH data capture, and much more. The NP SAN listserv is still active, providing valuable Lunch n’ Learn webinars with CE for participants. You can join the NP SAN listserv here. NNCC looks forward to providing ongoing practice transformation services to clinicians and practices, supporting successful transition into APMs, and identifying the critical role of nursing to drive the healthcare workforce of the future.

Guest Author: Tina Wright, Director, Emergency Management, Massachusetts League of Community Health Centers

Healthcare is a highly regulated industry on not only the federal and state levels, but also by accreditation and safety standards. After reviewing the severe damage following disasters (including severe weather such as Hurricanes Katrina and Sandy and human-made disasters such as utility accidents), the Centers for Medicare and Medicaid Services (CMS) established minimum emergency preparedness requirements which went into effect in 2016. These requirements mandate that healthcare providers and facilities focus on continuity of care for patients during emergencies.

The minimum requirements established by the original CMS emergency preparedness rule include creating and maintaining an Emergency Management (EM) program, which consists of conducting an all-hazards risk assessment, creating an emergency plan, as well as policies and procedures related to the plans, creating an emergency communications plan, and training staff on an annual basis and testing program elements through two (2) annual exercises. Since this was the first time for many healthcare providers to do any kind of emergency preparedness activities beyond standard fire evacuation drills, health centers and other facilities struggled to meet the minimum set forth and enforced by CMS and advised that the rule exacerbated healthcare providers’ already excessive administrative burden.

Changes specific to federally qualified health centers (FQHCs) include changing annual maintenance of emergency management programs to every other year. Other changes include:

What do these changes mean to health centers today?

Ideally, the changes will result in staff relief, a reduction of the burden of proof, and flexibility to allow more time to update the various elements throughout the health center’s EM Programs. EM leads at health centers are now able to alter timelines of their activities, which offers more opportunities for improving processes, including the ability to continually onboard and train staff on components of the EM Program and focus on cultivating a culture of preparedness throughout their health center. However, there is concern that the burden reduction will lead to a drop in support and buy-in from facility leadership, and an assumed decline in participation with local and regional healthcare preparedness coalitions and other emergency management activities. An additional concern is that these changes will cause added confusion, and may conflict with other EM requirements set forth by individual states and accreditation agencies (such as the Joint Commission).

As the CMS rule for burden reduction changes went into effect on November 27, 2019, the Health Resources and Services Administration (HRSA) is now tasking Primary Care Associations (PCAs) nationally to take up targeted EM activities in the 2020-2023 project cycle. HRSA’s overarching goals for the enhancement of FQHC emergency preparedness includes increasing formal agreements between health centers and PCAs for the purposes of operational status reporting, as well as increasing the amount of EM training and technical assistance to health centers while leveraging the CMS rule and alignment with HRSA resources. Many PCAs across the country have participated in the PCA Emergency Management Advisory Coalition (click here to visit EMAC), a high-functioning peer group of professionals devoted to emergency management and serving the needs of FQHCs and Look-alikes. Through EMAC, training, education, and various tools on the CMS rule have been shared since 2013, and while HRSA is now making EM for health centers a priority across the country, health centers have seen the value and return on investment for their facilities and patients to continue to enhance their abilities to prepare for, respond to, and recover from emergencies and disasters.

What does the future hold for health centers in EM?

Through the CMS requirement for planning for continuity of care of patients, and with the HRSA overarching EM goal, health centers will be provided targeted support from both PCAs and other National Training and Technical Assistance Partners (NTTAPs) collaborating on EM Programs with the intent to improve operations and restore continuity of services for their patients. Because health centers are rooted in responding to the emerging needs of their communities, it is not surprising that most identify their role in EM to be similar to what they do every day, and are well-positioned to continue to enhance their operational readiness to be community responders.

Want to learn more about the CMS rule and recent changes to its requirements? Take a look at NNCC’s CMS Rule Checklist, now updated to reflect the CMS burden reduction changes.

Stay Connected to Nurse-Led Care

Seventeen National Nurse-Led Care Consortium staff are presenting at the American Public Health Association's 2019 Annual Meeting. Our staff join the 67 PHMC employees who are presenting at APHA 2019. See the list of presentations and presenters below to find our staff. Click the title of the presentation for more details, including a session description and location.

Monday, November 4, 2019

Tuesday, November 5, 2019

Wednesday, November 6, 2019

Stay Connected with Nurse-Led Care