CAPC Annual Report 2012

2012 Annual Report

2012.

The year of:

• Serving as a resource in developing policies for

n The United States Supreme Court decision to uphold

Six years after the passage of the Massachusetts

the Affordable Care Act (ACA)

health care coverage reform law, Chapter 224

the Medical School’s primary care service learning

promotes value-based health care through the

contract program; and

• Collaborating with other departments to support

n The Commonwealth of Massachusetts enactment

improvement of quality and reduction of costs. PCPs

of Chapter 224: An Act Improving the Quality of

and the relationships they have with their patients are

faculty level quality improvement training through

Health Care and Reducing Costs through Increased

instrumental to the achievement of these goals.

the Quality Scholars Program.

Transparency, Efficiency and Innovation Chapter 224 identifies the critical importance of

CAPC has supported and tested new models of

investing in primary care through the establishment

primary care delivery. We are pleased to announce

of a Health Care Workforce Transformation Fund and

that two of our primary care practices, Barre Family

Each event will have long-term impacts on the delivery

support of programs such as: Health Care Workforce

Health Center, a Family Medicine residency site, and

of and payment for health care in the United States

Loan Repayment Program; a new Primary Care

Hahnemann Internal Medicine Group, a community-

and Massachusetts. They will shape the redesign of the

Residency Grant Program, established to finance the

based site, both achieved NCQA Level 3 Patient

primary care model and will influence the characteristics

training of PCPs at community health centers (CHCs);

Centered Medical Home recognition in 2012. Several

of the primary care workforce of the future.

and a new Primary Care Workforce Development and

other practices in our network are on the way to

Loan Forgiveness Grant Program, designed to enhance

applying for this recognition. Others are transforming

Many provisions in the ACA are linked specifically to

recruitment and retention of PCPs and other clinicians

in ways that build on their individual practice

primary care, such as:

at CHCs.

strengths. Much exciting work remains to spread these

n The reelection of Barack Obama

• Increased Medicaid payments to primary care physicians (PCPs)

• Coverage of preventative health services • Increased access to PCPs in primary care shortage Patient-Centered Medical Home (PCMH) Project Manager Heather Strother designed the word cloud graphic on the report’s cover. Providers and staff at the six pilot PCMH practices were asked the question: “Since your practice started its PCMH transformation journey, what accomplishment do you feel most proud of?” Based on the number of mentions by respondents, the words are larger — both “Patients” and “Care” are prominent.

innovations to meet our goal of providing patient- and The work of the Center for the Advancement of

family-centered, value-based care.

Primary Care (CAPC), a joint initiative of the University of Massachusetts Medical School and UMass Memorial

This annual report summarizes CAPC’s work from

Health Care, is well aligned with the new national and

September 2011 to December 2012 in the following

Massachusetts paradigms for the delivery of health

areas:

programs and health care workforce loan repayment

care. Since CAPC’s inception, it has focused on primary

programs

care workforce issues by:

• Primary Care Redesign • Workforce • Data and Analysis • Quality Improvement • Communication and Promotion • Education and Outreach

areas through Medicare payment bonuses

• Enhancements to federally supported student loan

• Scholarships for disadvantaged students who commit to serving as PCPs in underserved areas

• Distribution of additional residency positions for training PCPs

• Increases to the authorization of spending for the National Health Service Corps

• Establishment of a Medicare payment system for

• Studying the supply and demand of PCPs in Central Massachusetts;

• Working with medical students and practicing clinicians to identify attitudes toward careers in primary care;

• Tracking net growth in PCPs for the clinical system’s primary care network;

Federally Qualified Health Centers

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Primary Care Redesign

The Barre Family Health Center, a family medicine residency teaching site serving more than 6,000 patients, received

The drive to identify sustainable, cost-effective ways to deliver high quality patient-centered care

National Committee for Quality Assurance (NCQA)

continues at the national and state levels; the primary care practice remains at the core of these efforts.

recognition as a Level III (the highest) Patient Centered

In Central Massachusetts, the Center for the Advancement of Primary Care (CAPC) continues to help

Medical Home in July; the Hahnemann Internal Medicine

practices transform and redesign their work to focus on: improving access; managing populations;

Group, a community-based internal medicine practice,

increasing coordination and tracking of referrals; engaging and motivating patients; and better aligning

received its Level III designation in December. The two

physician and staff resources with the services being provided.

practices represent the first primary care sites in the UMass Memorial system to receive NCQA PCMH recognition.

UMass Memorial Patient-Centered Medical Home Where the focus is on you and your health

Barre Family Health Center A Family Medicine Residency Practice Recognized by the National Committee for Quality Assurance

UMass Memorial Patient-Centered Medical Home Where the focus is on you and your health

Hahnemann Internal Medicine Group

Practice Redesign Tools

Recognized by the National Committee for Quality Assurance

Practice improvement facilitators (PIFs) providing experience and training in quality improvement brought tools such as Lean Manufacturing methods and Plan-Do-Study-Act cycles to staff at primary care practices. Practice-specific protocols were developed to manage patient care at the time of appointment as well as through outreach. CAPC facilitated the sharing of best practices, such as for standard tasking protocols, through the PIFs and regular webinars. Training in Motivational Interviewing was promoted to support the process of engaging and motivating patients. CAPC supported practice training in the use of Patient Care Registries produced by the Office of Clinical Integration and piloted care management tools such as a high-risk registry and patient-specific care plans.

Patients: The Largest Health Care Workforce Available

“

Investing in patients to give them the knowledge, confidence and tools that enable them to become an effective and reliable workforce will be essential to maintain, and hopefully improve, the quality of care for most long-term illnesses.� ~ Cleland, JGF, Ekman, I. JAMA, 2010;304(12):1383-4.

Saturday Urgent Care: CAPC facilitated a multi-department UMass Memorial Medical Center and UMass Memorial Medical Group initiative to develop and expand urgent care access on Saturday mornings.

The main goal of the initiative: Provide non-emergency department access for urgent care to our patients on Saturdays. The initiative built on existing access to pediatric urgent care services on Saturdays for patients of the Benedict Pediatric practice. The initiative was expanded to include adult urgent care services and was offered to all patients at Medical Group practices in the greater Worcester service areas. From May through December, the Saturday Urgent Care service provided

Patient-Centered Medical Home Programs: Active practice redesign continued at

care to more than 700 pediatric and adult patients.

six UMass Memorial Health Care primary care sites caring for more than 30,000 patients. CAPC, in collaboration with the Office of Clinical Integration, provided infrastructure, personnel (PIFs, care managers and a nutritionist), training and financial support to the Barre Family Health Center and the Benedict Pediatrics Practice (both participants in the Massachusetts statewide Patient Centered Medical Home Initiative), Hahnemann Family Health Center, Plumley Village Health Services, Hahnemann Internal Medicine Group and Nashaway Pediatrics Clinton.

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Workforce

Data & Analysis

Health care reform efforts at the national and

learning opportunities to practicing physicians,

The Center for the Advancement of Primary Care (CAPC) provided

state level include provisions for increased funding

which supports a strong retention strategy.

data-driven analysis in support of the strategic goals of UMass

support for the training of physicians who choose

Medical Education: Barbara Weinstein served as

primary care careers, underscoring the compelling

an advisor to two student leaders for the Primary

evidence that health care outcomes and costs are

Care Principles (PCP) Group, formerly the Generalist

strongly linked to the availability of primary care.

Today, the 500 primary care physicians and their staffs who are employed by or affiliated with UMass Memorial Health Care represent a large workforce providing patient-centered care in Central Massachusetts. In the future, a number of students at UMass Medical School and the Graduate School of Nursing will also join the primary care workforce.

Memorial Health Care and for decisions affecting primary care.

Support for one-time analysis and ongoing tracking reports was provided to multiple departments.

Physician Program Interest Group. She also

Patient Population: In partnership with the Information

represented CAPC on the Medical School Learning

Services Department, CAPC produced an estimate of the patient

Contract Committee, which reviews requests for

population attributed to employed primary care physicians.

tuition forgiveness based on post-training careers

Quarter-to-quarter changes were tracked and reported to the

in primary care, public service or underserved

UMass Memorial board of trustees. Discussions commenced with

communities.

representatives of UMass Memorial Medical Group and the Office

CAPC contacted all applicants offered admission

of Clinical Integration (OCI) to develop physician-specific covered

to UMass Medical School, welcoming them in an

lives estimates using the OCI Patient Care Registries.

Recruitment: In collaboration with the Physician

email. The communication emphasized the school’s

Recruitment Office, the Center for the Advancement

resources in primary care and offered to connect

Primary Care Physician Database: Francis Wanjau, practice

of Primary Care (CAPC) produced a dashboard

students with a member of the primary care faculty.

improvement facilitator, maintained and refined information about

to track growth of primary care physicians in the

all primary care physicians with affiliations to UMass Memorial

UMass Memorial Health Care system. The Primary

Student Survey on Choice of Specialty: CAPC

Health Care. The information was used to enhance recruitment

Care Recruitment and Retention Advisory Group,

facilitated the administration of an annual survey

tracking, target communication activities and support analysis to

comprising representatives from multiple primary

of fourth-year UMass Medical School students.

estimate patient population.

care disciplines, met regularly to coordinate

The survey asks students to share how they

recruitment activities across all hiring departments,

arrived at their career decisions and what their

Expanded Primary Care Access: CAPC provided analytical

review quarterly results, and share hiring and

experience with the primary care specialties has

support in the development and expansion of Saturday Urgent

retention strategies.

been throughout medical school. The survey

Care Access for adults and children. Analysis included volume

design and analysis were developed by members

trends; emergency department usage; and financial results.

Retention: CAPC supported 10 physicians who were members of the third class of Quality Scholars; four of those scholars were in primary care-related departments. The program provides continuous

“Being a primary care doctor is more than just being a physician; it’s being a partner, an ally and a friend.”

Mohmmad Hajjiri, MD Montachusett Internal Medicine, Leominster

of the Department of Family Medicine and Community Health, and the survey’s distribution

Practice Redesign: CAPC developed and had oversight for

was undertaken by former student leaders of the

production of reports contractually required for the Massachusetts

Primary Care Principles interest group.

Multi-Payer Patient-Centered Medical Home Initiative. CAPC also piloted the use of a high-risk registry in several medical home sites.

“As a primary care physician, I have the chance to make a real difference in my patients’ lives. I value the relationships we have, and view every encounter as a learning opportunity.”

Allen Chang, MD, Benedict Internal Medicine, Worcester 6

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Quality Improvement The Center for the Advancement of Primary Care (CAPC) continued to integrate principles and tools endorsed and supported by UMass Medical School and UMass Memorial Health Care into its primary care redesign work to engage physicians and staff in quality improvement at the practice/department level.

Quality Scholars Program: The Quality Scholars Program graduated its third class of scholars in June.

The program, co-directed by the UMass Memorial Department of Quality and Patient Safety and CAPC,

2012 Quality Scholars Bronwyn Cooper, MD (Anesthesiology), Reducing Late First Start Times of Caesarean Sections Alan Picarillo, MD, mentor, Department of Pediatrics Christine Donahue, MD (Hospital Medicine), Reducing Time to Admission Orders: An ED Transition to Inpatient Flow Initiative Peter Paige, MD, mentor, Department of Emergency Medicine

originated with support from a HRSA training grant

David Geist, MD (Dermatology), Reducing Post-

Improving Fluid Resuscitation in Patients with

to bring quality improvement and patient safety

Mohs Surgical Infections

Sepsis-Induced Hypotension

curriculum into UMass Medical School, primary care

Elizabeth Murphy, MD, mentor, Department of

Roger Luckmann, MD, MPH, mentor, Department of

residencies and faculty development; it is now entirely

Medicine

Family Medicine and Community Health

Richard Lerner, MD (Internal Medicine/Primary

Theodore Shoemaker, MD (Family Medicine/

Care), Using an Exercise Prescription to Increase

Primary Care), Increasing the Accuracy of Preventive

Physical Activity Level

Health Documentation in an Electronic Medical

Mitchell Gitkind, MD, mentor, Departments of

Record

Medicine and Surgery

Judith Savageau, MPH, mentor, Department of Family

supported with internal funding. The 10 scholars and their mentors represent a mix of primary care and specialty departments working and teaching in inpatient and ambulatory settings, underscoring the opportunities to incorporate quality improvement across the continuum of care.

Peter McConarty, MD (Family Medicine/Primary

“Effective primary care is rooted in the ability to communicate, not only with the patient, but also with the entire care team.”

Nancy Skehan, MD Benedict Internal Medicine, Worcester

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Shahrzad Shidfar, MD (Hospital Medicine),

Afroz Saquib, MD Shrewsbury Primary Care, Shrewsbury

Medicine and Community Health

Care), Optimizing Influenza Immunization of Diabetics

Marie Anne Sosa, MD (Hospital Medicine),

Rocco Perla, EdD, mentor, Department of Family

Improving the Management of Patients with

Medicine and Community Health

Severe Hyponatremia; Peter Gibson, MD, mentor,

Elise Pyun, MD (Rheumatology), Improving Patient

“My goal is to empower patients with knowledge about their illness and partner with them in their treatment and recovery plan.”

Department of Medicine

Flow in the Rheumatology Center Lisa Allen, PhD, mentor, Department of Quality and Patient Safety Jennifer Reidy, MD (Palliative Care), Improving the Use of Patient-Controlled Analgesia Trudy Manchester, MD, mentor, Department of Medicine

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Communication & Promotion

Annual Medical Student Primary Care Dinner: The CAPC, Meyers Primary Care Institute and the Office of Educational Affairs sponsored

Health care reform efforts are beginning to recognize the value of primary care in meaningful ways, yet it remains a challenge to demonstrate that value to numerous constituencies, including medical students, provider and payers. In a previous Center for the Advancement of Primary Care (CAPC) Needs Assessment Survey of primary care physicians, improving the image of primary care at UMass Memorial Health Care and UMass Medical School was the number one area respondents requested that CAPC address. See “Survey Finds Elements of High Career Satisfaction…” Primary Care News, January 2009.

the 18th and 19th Medical Student Primary Care Dinners, organized by the PCP Group student leaders. The 2011 speaker was David Hatem, MD, associate professor, Department of Medicine and a practicing physician at the Benedict Adult Internal Medicine practice; the 2012 speaker was Frank Domino, MD, professor, Department of Family Medicine and Community Health and a practicing Family Medicine physician in a community practice.

CAPC organized and supported activities designed to promote the value and diversity of primary care and

Webinars: Prime Time Conversations and Pathways to PCMH Success,

disseminated information to primary care practices and patients through webinars and e-newsletters.

two interactive webinar programs, were broadcast more than 50 times. The

National Primary Care Week: UMass Medical School and UMass Memorial Health Care celebrated National Primary Care Week during the first week of October in 2011 and 2012. The activities represented an opportunity for students to learn more about primary care and for the Medical School and clinical system to express appreciation to the many physicians, clinicians, nurses and staff who care for patients through a primary care relationship and who are teaching the next generation of caregivers.

At the Medical School, CAPC coordinated programming for the observances with the MassAHEC Network; Meyers Primary Care Institute; the Office of Medical Education; the Office of Educational Affairs; the Graduate School of Nursing; the Humanities in Medicine Committee of the Lamar Soutter Library; and many student interest groups, led by the Primary Care Principles Group.

At UMass Memorial Health Care, grand rounds during the week featured topics relevant to primary care (2011 Medicine Grand Rounds, Quality Scholars presentations; 2012 Pediatrics Grand

programs, available for on-demand listening in podcast format, covered topics of general interest to primary care practices and topics targeted specifically to redesigning care processes for success in transforming to patient-centered medical homes and in achieving pay for performance goals.

Newsletters: The CAPC distributed Primary Care News, its general primary care quarterly electronic newsletter, to the broad primary care community and interested parties. It continued to produce two patient education newsletters, Stick to It (diabetes) and Pressure Points (hypertension). The patient newsletters highlight the important partnership in caring for chronic disease between primary care and two specialties at UMass

The Primary Care Dinner brought together the following physicians and students (top): Elizabeth Murphy, MD, Benedict Internal Medicine, and Caleb Dresser, Medical School Class of 2015.

Benjamin Vaughan, one of two student co-leaders of Primary Care Principles Group, with Frank Domino, MD, professor, family medicine and community health and 2012 speaker.

Memorial: the Diabetes Center of Excellence and the Heart and Vascular Center of Excellence. The PCMH program also produced an email newsletter which included care redesign best practices, Massachusetts and national medical home updates and other announcements.

Rounds, Chapter 224 — Payment Reform in Massachusetts). Public ads thanking clinical professionals and staff at employed and affiliated primary care practices appeared in newspapers in all UMass Memorial service areas; each practice also received a letter of thanks from the CEO. Primary care physicians were featured in computer screensavers, visible to staff and patients. The family medicine, general pediatrics and internal medicine practices located on the University Campus coordinated a community flu clinic during the 2012 celebration.

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Education & Outreach Center for the Advancement of Primary Care (CAPC) staff and others supported by CAPC had numerous opportunities during the year to share their experiences in practice transformation, quality improvement, and to engage patients and the community in wellness and prevention activities.

January 2012

Plumley Village Health Services, Worcester, MA

Massachusetts Patient-Centered Medical Home

Six-week external program Cooking Matters!

Initiative, Learning Session 4, Worcester, MA

Margaret Apura, MPH, RD, LDN

Diabetes Process and Outcome Measures: Achieving Improvement Overcoming Analysis Paralysis: Just Do It Ronald Adler, MD ————————­­­­­­­­­­­­— ————————————— Integrating Behavioral Health: Practical Strategies for PCPs and Mental Health Providers F. Alexander Blount, EdD, and Ronald Adler, MD ————————­­­­­­­­­­­­— ————————————— UMass Worcester Graduate School of Nursing

April 2012 Quinsigamond Community College UMass Memorial Community Relations Margaret Apura, MPH, RD, LDN ————————­­­­­­­­­­­­— ————————————— Clinton Resource Center Healthy Eating Presentation for parents and families Margaret Apura, MPH, RD, LDN, and

Simulation

Lucy Kanjer-Larson, MD

Lisa Ogawa, RN, PhD, and Francis Wanjau, MS

March 2012

Rhode Island Quality Institute, Keynote Address

Academic Pediatric Association Region 1 Meeting,

Addressing the Challenges of Practice Transformation

Sturbridge, MA

Ronald Adler, MD ————————­­­­­­­­­­­­— ————————————— Belmont Street Community School

Ronald Adler, MD, and Beth Murphy, MD ————————­­­­­­­­­­­­— ————————————— Hahnemann Internal Medicine Group, Shared Medical

UMass Memorial Community Relations Healthy Eating Presentation Margaret Apura, MPH, RD, LDN

Appointments Margaret Apura, MPH, RD, LDN, Brenda King, PsyD, LMHC, LCC, and Janice Polletta, NP ————————­­­­­­­­­­­­— ————————————— University of Massachusetts Medical School Be Mentally Well – Managing the Impact of Alzheimer’s Disease Brenda King, PsyD, LMHC, LCC ————————­­­­­­­­­­­­— ————————————— 12

Connecticut AHEC, University of Connecticut School

The Fairbridge Project International/The AIDS Project

of Medicine and Connecticut Department of Public

Worcester

Health

Healthy Eating Table

Diabetes Care in the Patient-Centered Medical Home

Margaret Apura, MPH, RD, LDN ————————­­­­­­­­­­­­— ————————————— Hahnemann Internal Medicine Group

Ronald Adler, MD ————————­­­­­­­­­­­­— ————————————— American Academy of Medical Colleges Workshop

Shared Medical Appointments

– Quality Improvement and Medical Education,

Margaret Apura, MPH, RD, LDN, Brenda King, PsyD,

Chicago, IL

and Janice Polletta, NP

Workshop Participant Judith Savageau, MPH

October 2012 Worcester Partnership for Quality Elder Mental Health

July 2012

Care, Worcester Senior Center

High School Health Careers Program

“Tis Better to Have Loved and Lost: Successfully

Contemporary and Cultural Health Issues Seminar

Navigating the Waves of Change in Late Life”

Educational Experiences from a Third World

Brenda King, PsyD ————————­­­­­­­­­­­­— ————————————— UMass Memorial Community Relations

Perspective Francis Wanjau, MS

Worcester YWCA Healthy Eating presentation for teen mothers

May 2012

Improvement

September 2012

Healthy Eating Presentation for ESL students

Teaching Track Team Building: Mr. Potato Head

Think QuiC! Using Mr. Potato Head to Teach Quality

June 2012

“I chose to practice primary care at UMass Memorial because it feels like a tangible way to serve my community.”

Carolyn Keiper, MD Pediatric Primary Care Associates, Worcester

August 2012

Margaret Apura, MPH, RD, LDN

National Night Out UMass Memorial Medical Center, Worcester, MA

December 2012 STFM/AAFP Conference on Practice Improvement, Greenville, SC Addressing the Challenges of Practice Transformation: Lessons Learned on the Journey from Disease-specific Collaboratives to Patient-Centered Medical Homes Ronald Adler, MD

At National Night Out in August, from left: Dieticians Margaret Apura, MPH, RD, LDN, from CAPC, and Linda DeNering, MS, RD, LDN, and Sara Graves, MA, RD, LDN, RN, from the Memorial Campus of the Medical Center.

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Center for the Advancement of Primary Care University of Massachusetts Medical School | UMass Memorial Health Care Organization

Robert Klugman, MD

Chief Quality Officer; Medical Director, Managed Care, UMass Memorial

Medical Center

Daniel Lasser, MD, MPH

Senior Vice President

Daniel Lasser, MD, MPH*

Senior Vice President, Center for the Advancement of Primary Care;

Barbara Weinstein, MBA

Senior Director

Chair, Department of Family Medicine and Community Health

Ronald Adler, MD, FAAFP

Director, Primary Care Practice Improvement

Andrew Miller, MD

Clinical Chief, Community Internal Medicine

Michele Pugnaire, MD

Senior Associate Dean for Educational Affairs, UMass Medical School

Margaret Apura, MPH, RD, LDN Dietitian

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Janet Hale, PhD, APRN, BC, FNP Associate Dean for Academic Programs, Graduate School of Nursing

Brenda King, PsyD, LMHC, NCC

Medical Home Care Advisor

Jason Nigrosh, MM

Practice Improvement Facilitator

Linda Sagor, MD, MPH*

Division Director, General Pediatrics

Francis Wanjau, MS

Practice Improvement Facilitator

Barbara Weinstein, MBA*

Senior Director, Center for the Advancement of Primary Care

Jennifer Masoud

Administrative Assistant

Bruce Weinstein, MD

Clinical Chief, General Medicine and Primary Care

Lynda Young, MD

Division Director, Community Pediatrics

Advisory Committee (*Also serves on the Executive Committee)

Douglas Ziedonis, MD, MPH

Chair, Department of Psychiatry

Ronald Adler, MD, FAAFP*

Director, Primary Care Practice Improvement, Center for the

Jeremy Konstam

UMass Medical School student, Class of 2015

Advancement of Primary Care

Benjamin Vaughan

UMass Medical School student, Class of 2015

Julia Andrieni, MD, FACP*

Vice Chair of Medicine (Clinical Services); Chief, Division of General

Internal Medicine

Joseph Antaki, MD

Tri-River Family Health Center

Robert Baldor, MD

Vice Chair of Education, Department of Family Medicine and

Community Health

Charles Cavagnaro, MD

President and CEO, Wing Memorial Hospital and Medical Centers

Primary Care Recruitment and Retention Advisory Group

Alan Chuman, MPH*

Academic Administrator, Department of Family Medicine and

Julia Andrieni, MD, FACP

Community Health

Arnold (A.J.) Avila, MEd

William Corbett, MD*

Vice President of Community Practices, UMass Memorial Medical Group

William Corbett, MD

Sheila Daly, MS

President and CEO, Clinton Hospital

With thanks to the following Advisory Committee members who served during the year: Nicholas Avgerinos

UMass Medical School student, Class of 2014

Jessica Boatman

UMass Medical School student, Class of 2014.

Daniel Lasser, MD, MPH Katherine Pryor

Eric Dickson, MD, MHCP, FACEP Interim President, UMass Memorial Medical Group

Michele Streeter, CPA

Dennis Dimitri, MD, FAAFP*

Vice Chair of Clinical Services, Department of Family Medicine and

Barbara Weinstein, MBA

Community Health

With thanks to Lynne Kosloski and Paul Wesolowski for their service during the year.

David Fairchild, MD, MPH

Senior Vice President Clinical Integration, UMass Memorial Health Care

Barbara Fisher, MBA

Senior Vice President, Operations, UMass Memorial Medical Center

Jerry Gurwitz, MD*

Executive Director, Meyers Primary Care Institute

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Patient Centered Medical Home (PCMH) Program

2012 Quality Scholars Program

Staff and Committee Members

Graduates

Ronald Adler, MD, FAAFP

Bronwyn Cooper, MD

Assistant Professor, Department of Anesthesiology, UMass Memorial

Margaret Apura, MPH, RD, LDN

Medical Center – University Campus

Christine Donahue, MD

Assistant Professor, Department of Medicine, Marlborough Hospital

David Geist, MD

Assistant Professor, Department of Medicine, UMass Memorial Medical

Center – Hahnemann Campus

Richard Lerner, MD

Assistant Professor, Department of Medicine, UMass Memorial Medical

Center – University Campus

Peter McConarty, MD

Associate Professor, Department of Family Medicine and Community

Health, Community Health Connections, Fitchburg Community Health

Dianna Caffarena, MBA Christine Cernak, RN, CDE William Corbett, MD Elaine Fontaine Daniel Lasser, MD, MPH Jason Nigrosh, MM Heather Strother, MPH Francis Wanjau, MS Barbara Weinstein, MBA Qiyao Zhang, MD, PhD

“Caring for patients always includes listening.

The best treatment plan starts with understanding your patient and where they’re coming from.”

Kristin Mallett, MD Benedict Family Medicine, Worcester

Center Elise Pyun, MD

Clinical Associate Professor, Department of Medicine, UMass Memorial

Medical Center – Memorial Campus

Jennifer Reidy, MD

Assistant Professor, Department of Family Medicine and Community

Health, UMass Memorial Medical Center – Memorial Campus

David Keller, MD

Shahrzad Shidfar, MD

Assistant Professor, Department of Medicine, UMass Memorial Medical

Edward Westrick, MD

Center – Memorial Campus

Theodore Shoemaker, MD

Assistant Professor, Department of Family Medicine and Community

Health, Family Health Center

Marie Anne Sosa, MD

Assistant Professor, Department of Medicine, UMass Memorial Medical

Center – University Campus

With thanks to the following who served during the year: Arlene Ash, PhD Alexander (Sandy) Blount, EdD Amy Finn, PharmD, PhD, MBA

Participating PCMH Practices Barre Family Health Center*, designated as a Level III Patient Centered Medical Home and Residency Site by the NCQA (National Committee for Quality Assurance) Benedict Pediatrics*

Co-directors

Hahnemann Family Health Center

Mitchell Gitkind, MD

Associate Chief Quality Officer, Clinical Associate Professor of Medicine

Hahnemann Internal Medicine Group, designated as a Level III Patient Centered Medical Home by the

and Surgery

NCQA

Judith Savageau, MPH

Associate Professor of Family Medicine and Community Health

Nashaway Pediatrics Clinton Plumley Village Health Services *Participants in the Massachusetts PCMH Initiative

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Center for the Advancement of Primary Care 55 Lake Avenue North, Benedict Building A3-221 Worcester, MA 01655 Tel: 508-442-7050 capc@umassmemorial.org

www.umassmemorial.org/capc