December 1-3, 2015, the Centers for Medicare and Medicaid Services (CMS) held its annual Quality Conference in association with a meeting of the potential faculty for the Transforming Clinical Practice Initiative (TCPI).  During that meeting, CMS asked those attending the TCPI Faculty meeting for their “ask and their offer.”  The “ask” was what the faculty needs from CMS and the “offer” was what each faculty member would provide to CMS for the success of this program.  The request was that the “offer” be completed within two months.

SETMA’s “offer” was that our website would be modified to provide one of many “libraries” for materials, guides and instructions about practice transformation.  This would be based on SETMA’s twenty-year history of practice transformation.  This offer was made during the Quality Conference on December 3rd.  SETMA began the project on December 4th and on the day before Christmas, December 24th, the completed project was distributed to CMS’ TCPI leadership and to members of the TCPI project.

The following is a copy of the introduction to this project which is posted on our website and which was sent to the leadership:

“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.  SETA’s 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:

1. The Introduction to SETMA's TCPI Library, this is the one-page introduction which you are presently reading.
2. 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.  
3. Summary To Entire TCPI.  This a two part summary of the entire library:


1. Summation of SETMA's TCPI Website -- This is an 11-page list of hyperlinks which allow you to easily access the entire library.
2. 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:

1. CMS Quality 12.2015 TCPI
2. Leadership and Governance
3. Care Coordination
4. HIPPA and Security
5. Data Analytics
6. Care Transitions
7. LESS Initiative
8. Medical Records
9. Clinical Decision Support
10. Hospital Care Tools
11. Disease Management Tools
12. Preventive Health Tools
13. Behavioral Health
14. Transformation Tools
15. New Transformation Tools
16. Patient-Centric Care
17. Nursing Home
18. Medical Home
19. Display and Explanation of SETMA’s Patient-Centered Medical Home Tools”

The first step in this project was the writing of an 88-page document entitled, “Overview and the Philosophical Underpinnings to SETMA’s Website (www.jameslhollymd.com) which is SETMA’s Offer” to the Center for Medicare and Medicaid Services’ (CMS) Transforming Clinic Practice Initiative TCPI).”  This document began with the review of a series of questions submitted to me on May 21, 2015 by the Medical Home News (see Medical Home News, Questions for “Catching up with Dr. James L. Holly,” May 2015).  The first question addressed what I think is the most critical part of “practice transformation.”  It was, “You have an extraordinary passion for your practice, your patients, and you pursuit of excellence.  Where does that passion come from?”

In this first document, the following was said to the participants in the TCPI, “As you read the following, which is my answer to question one above, and as you recognize that this answer derives from my personal story, you should substitute your words and your story for mine.  While this introduction to the intent and dynamic of the TCPI is based on my experience, its ultimate value will be as it provokes you to share your story within your own practice, community and within the TCPI community.  There is an old adage which states, ‘It’s my way or the highway,’ TCPI modifies that to say, ‘This is our highway; it is an example from which you can build your personal highway.’  The building of that highway requires that you be willing to face where you are and who you are, as you envision where and what you want to become.  It is founded upon the implications of Abraham Lincoln’s 1858 declaration:  ‘If we can first know where we are and whither we are tending; we can better judge what to do and how to do it.’”

Each of the participants in TCPI will need to identify their personal passion and to discover its source.  It is that passion which will be the engine and which will provide the fuel for the sustaining of this process.  This is my story; your success will be guided and sustained by your remembering and recording your story.

The Source of My Passion

My father did not go to college but started work as a laborer with Louisiana Power & Light Company.  In 1947, when I was four, we moved to a company house at Camp Livingston, a decommissioned, military base outside of Ball, Louisiana.  Our family of four shared a two-bedroom house with another family.  My father traveled to Monroe every Monday morning and returned Friday night.  Within a year, he ran the power station at Camp Livingston and we moved to Natchitoches where he ran the power company’s interests over a large part of north Louisiana including Camp Polk which would become Fort Polk.  Graduate engineers were sent to him for training.  I watched his self-sustaining energy and drive, and his commitment to excellence without supervision and without guidance.  I saw rich, educated and powerful men defer to my father because of his character and personal integrity.  I learned.

Years later, while riding down an unpaved, country road, my father stopped and hailed a man plowing in the field.  The man walked over and my father said, “I thought you were going to be by the house last Friday?”  The man responded, “One of the kids got sick but I’ll be there this week.”  As we drove on, I asked my father what that was about.  He said, “He couldn’t pay his light bill and I paid it for him.”  This was Louisiana, my father was Caucasian and his friend was African-American.  I learned.  He would never let children go without heat and power.  Although he made less than $5,000 a year, he was never without money to help others.

As my social liberalism grew, my father expressed concern.  He had lived a life of compassion and kindness to others, but had never opposed his culture.  I started aggressively opposing that culture when I was 17.  I responded to my father’s concern and said, “Daddy, everything I believe and everything I do, I learned from you.”  As my personal faith grew, it only reinforced the lessons I had learned from my father until I would define myself as “a social liberal, a fiscal conservative and a theological fundamentalist. “   My father is deceased, but I still live with a desire to be like him, to be a man of integrity, honor, compassion, and fearlessness. This is the source of my passion for medicine; it came from a man who never spent a day in college.