JamesLHollyMD.com

	James L. Holly, M.D.

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A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - 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Transforming Your Practice - Introduction to SETMA’s TCPI Library

www.jameslhollymd.com has been modified to provide a resource for CMS' Transforming Clinical Practice Initiative (TCPI). This program is intended to effect significant change in the practices of 140,000 primary care providers. The most challenging part of the TCPI is that the nature of transformation, as opposed to reform is that each person’s and each primary care practice’s process of transformation will be somewhat unique and the product will also be unique.

The absence of uniformity and/or standardization will make it difficult to measure outcomes; however, that is the price we pay for promoting and valuing transformation. The more regimentation and/or standardization in process the less generative energy and creative outcomes will be produced. This website is a description of SETMA’s transformative process. It is hoped that it will help others with their process analysis and ultimate with their unique transformation. This is not presented as a road map to be followed but as a journal for our unique journey as you prepare your trip.

It is our hope that this will benefit you, if in no other way than for you to know that others have achieved radical transformation which has benefited our patients, our practices and our performance. The only cost for your using this resource is the time and energy you will expend to understand its content. There is no monetary cost. Best wishes to you in your journey.

There are 22 sections to the Transforming Your Practice (TCPI) library of materials provided for this initiative. The first three sections are:

The Introduction to SETMA's TCPI Library, this is the one-page introduction which you are presently reading.
The second section is entitled Transforming Your Practice (TCPI) -- this is the overview and philosophical underpinnings which is SETMA's "offer" to CMS for the TCPI Initiative. It is an 88-page introduction to the site (see Transforming Your Practice in pdf format). Pages 49-88 is an annotated list of the content of the library.
Summary To Entire TCPI. This a two part summary of the entire library:

Summation of SETMA's TCPI Website -- This is an 11-page list of hyperlinks which allow you to easily access the entire library.
Summation of SETMA's TCPI Website in pdf format -- This is a 102-page PDF of the entire library which includes annotated hyperlinks to each section’s content.

The following are links into the remaining 19 sections of the library:

If you have questions about this material, you may contact me at jholly@jameslhollymd.com or with the information below.

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

(409) 504-4517

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

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