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The work of the Center for the Advancement of Primary Care (CAPC), a joint initiative of the University of Massachusetts Medical School and UMass Memorial Health Care, is well aligned with the new national and Massachusetts paradigms for the delivery of health care. Since CAPC’s inception, it has focused on primary care workforce issues, and supported and tested new models of primary care delivery. This annual report summarizes CAPC’s work from September 2011 to December 2012 in the following areas: Primary Care Redesign, Workforce, Data and Analysis, Quality Improvement, Communication and Promotion, and Education and Outreach.
Citation preview
2012 Annual Report
2 3
Patient-Centered Medical Home (PCMH) Project
Manager Heather Strother designed the word
cloud graphic on the reports 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.
n The United States Supreme Court decision to uphold the Affordable Care Act (ACA)
n The Commonwealth of Massachusetts enactment of Chapter 224: An Act Improving the Quality of
Health Care and Reducing Costs through Increased
Transparency, Efficiency and Innovation
n The reelection of Barack Obama
Each event will have long-term impacts on the delivery
of and payment for health care in the United States
and Massachusetts. They will shape the redesign of the
primary care model and will influence the characteristics
of the primary care workforce of the future.
Many provisions in the ACA are linked specifically to
primary care, such as:
Increased Medicaid payments to primary care
physicians (PCPs)
Coverage of preventative health services
Increased access to PCPs in primary care shortage
areas through Medicare payment bonuses
Enhancements to federally supported student loan
programs and health care workforce loan repayment
programs
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
Federally Qualified Health Centers
2012. The year of: Six years after the passage of the Massachusetts health care coverage reform law, Chapter 224
promotes value-based health care through the
improvement of quality and reduction of costs. PCPs
and the relationships they have with their patients are
instrumental to the achievement of these goals.
Chapter 224 identifies the critical importance of
investing in primary care through the establishment
of a Health Care Workforce Transformation Fund and
support of programs such as: Health Care Workforce
Loan Repayment Program; a new Primary Care
Residency Grant Program, established to finance the
training of PCPs at community health centers (CHCs);
and a new Primary Care Workforce Development and
Loan Forgiveness Grant Program, designed to enhance
recruitment and retention of PCPs and other clinicians
at CHCs.
The work of the Center for the Advancement of
Primary Care (CAPC), a joint initiative of the University
of Massachusetts Medical School and UMass Memorial
Health Care, is well aligned with the new national and
Massachusetts paradigms for the delivery of health
care. Since CAPCs inception, it has focused on primary
care workforce issues by:
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 systems
primary care network;
Serving as a resource in developing policies for
the Medical Schools primary care service learning
contract program; and
Collaborating with other departments to support
faculty level quality improvement training through
the Quality Scholars Program.
CAPC has supported and tested new models of
primary care delivery. We are pleased to announce
that two of our primary care practices, Barre Family
Health Center, a Family Medicine residency site, and
Hahnemann Internal Medicine Group, a community-
based site, both achieved NCQA Level 3 Patient
Centered Medical Home recognition in 2012. Several
other practices in our network are on the way to
applying for this recognition. Others are transforming
in ways that build on their individual practice
strengths. Much exciting work remains to spread these
innovations to meet our goal of providing patient- and
family-centered, value-based care.
This annual report summarizes CAPCs work from
September 2011 to December 2012 in the following
areas:
Primary Care Redesign
Workforce
Data and Analysis
Quality Improvement
Communication and Promotion
Education and Outreach
4 5
Primary Care RedesignThe drive to identify sustainable, cost-effective ways to deliver high quality patient-centered care
continues at the national and state levels; the primary care practice remains at the core of these efforts.
In Central Massachusetts, the Center for the Advancement of Primary Care (CAPC) continues to help
practices transform and redesign their work to focus on: improving access; managing populations;
increasing coordination and tracking of referrals; engaging and motivating patients; and better aligning
physician and staff resources with the services being provided.
Practice Redesign ToolsPractice 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.
Patient-Centered Medical Home Programs: Active practice redesign continued at 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.
The Barre Family Health Center, a family medicine residency
teaching site serving more than 6,000 patients, received
National Committee for Quality Assurance (NCQA)
recognition as a Level III (the highest) Patient Centered
Medical Home in July; the Hahnemann Internal Medicine
Group, a community-based internal medicine practice,
received its Level III designation in December. The two
practices represent the first primary care sites in the UMass
Memorial system to receive NCQA PCMH recognition.
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
care to more than 700 pediatric and adult patients.
UMass MemorialPatient-Centered Medical Home
Where the focus is on you and your health
Barre Family Health CenterA Family Medicine Residency PracticeRecognized by the National Committee for Quality Assurance
UMass MemorialPatient-Centered Medical Home
Where the focus is on you and your health
Hahnemann Internal Medicine GroupRecognized by the National Committee for Quality Assurance
6 7
Data & AnalysisThe Center for the Advancement of Primary Care (CAPC) provided
data-driven analysis in support of the strategic goals of UMass
Memorial Health Care and for decisions affecting primary care.
Support for one-time analysis and ongoing tracking reports was
provided to multiple departments.
Patient Population: In partnership with the Information
Services Department, CAPC produced an estimate of the patient
population attributed to employed primary care physicians.
Quarter-to-quarter changes were tracked and reported to the
UMass Memorial board of trustees. Discussions commenced with
representatives of UMass Memorial Medical Group and the Office
of Clinical Integration (OCI) to develop physician-specific covered
lives estimates using the OCI Patient Care Registries.
Primary Care Physician Database: Francis Wanjau, practice
improvement facilitator, maintained and refined information about
all primary care physicians with affiliations to UMass Memorial
Health Care. The information was used to enhance recruitment
tracking, target communication activities and support analysis to
estimate patient population.
Expanded Primary Care Access: CAPC provided analytical
support in the development and expansion of Saturday Urgent
Care Access for adults and children. Analysis included volume
trends; emergency department usage; and financial results.
Practice Redesign: CAPC developed and had oversight for
production of reports contractually required for the Massachusetts
Multi-Payer Patient-Centered Medical Home Initiative. CAPC also
piloted the use of a high-risk registry in several medical home sites.
WorkforceHealth care reform efforts at the national and
state level include provisions for increased funding
support for the training of physicians who choose
primary care careers, underscoring the compelling
evidence that health care outcomes and costs are
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.
Recruitment: In collaboration with the Physician
Recruitment Office, the Center for the Advancement
of Primary Care (CAPC) produced a dashboard
to track growth of primary care physicians in the
UMass Memorial Health Care system. The Primary
Care Recruitment and Retention Advisory Group,
comprising representatives from multiple primary
care disciplines, met regularly to coordinate
recruitment activities across all hiring departments,
review quarterly results, and share hiring and
retention strategies.
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
learning opportunities to practicing physicians,
which supports a strong retention strategy.
Medical Education: Barbara Weinstein served as
an advisor to two student leaders for the Primary
Care Principles (PCP) Group, formerly the Generalist
Physician Program Interest Group. She also
represented CAPC on the Medical School Learning
Contract Committee, which reviews requests for
tuition forgiveness based on post-training careers
in primary care, public service or underserved
communities.
CAPC contacted all applicants offered admission
to UMass Medical School, welcoming them in an
email. The communication emphasized the schools
resources in primary care and offered to connect
students with a member of the primary care faculty.
Student Survey on Choice of Specialty: CAPC
facilitated the administration of an annual survey
of fourth-year UMass Medical School students.
The survey asks students to share how they
arrived at their career decisions and what their
experience with the primary care specialties has
been throughout medical school. The survey
design and analysis were developed by members
of the Department of Family Medicine and
Community Health, and the surveys distribution
was undertaken by former student leaders of the
Primary Care Principles interest group.
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
Being a primary care doctor is more than just being a physician; its being a partner, an ally and a friend.
Mohmmad Hajjiri, MDMontachusett Internal Medicine,
Leominster
8 9
Quality ImprovementThe 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,
originated with support from a HRSA training grant
to bring quality improvement and patient safety
curriculum into UMass Medical School, primary care
residencies and faculty development; it is now entirely
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.
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
David Geist, MD (Dermatology), Reducing Post-
Mohs Surgical Infections
Elizabeth Murphy, MD, mentor, Department of
Medicine
Richard Lerner, MD (Internal Medicine/Primary
Care), Using an Exercise Prescription to Increase
Physical Activity Level
Mitchell Gitkind, MD, mentor, Departments of
Medicine and Surgery
Peter McConarty, MD (Family Medicine/Primary
Care), Optimizing Influenza Immunization of Diabetics
Rocco Perla, EdD, mentor, Department of Family
Medicine and Community Health
Elise Pyun, MD (Rheumatology), Improving Patient
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
Shahrzad Shidfar, MD (Hospital Medicine),
Improving Fluid Resuscitation in Patients with
Sepsis-Induced Hypotension
Roger Luckmann, MD, MPH, mentor, Department of
Family Medicine and Community Health
Theodore Shoemaker, MD (Family Medicine/
Primary Care), Increasing the Accuracy of Preventive
Health Documentation in an Electronic Medical
Record
Judith Savageau, MPH, mentor, Department of Family
Medicine and Community Health
Marie Anne Sosa, MD (Hospital Medicine),
Improving the Management of Patients with
Severe Hyponatremia; Peter Gibson, MD, mentor,
Department of Medicine
My goal is to empower patients with knowledge about their illness and partner with them in their treatment and recovery plan.
Afroz Saquib, MDShrewsbury Primary Care,
Shrewsbury
Effective primary care is rooted in the ability to communicate, not only with the patient, but also with the entire care team.
Nancy Skehan, MDBenedict Internal Medicine,
Worcester
10 11
Communication & PromotionHealth 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.
CAPC organized and supported activities designed to promote the value and diversity of primary care and
disseminated information to primary care practices and patients through webinars and e-newsletters.
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
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.
Annual Medical Student Primary Care Dinner: The CAPC, Meyers Primary Care Institute and the Office of Educational Affairs sponsored
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.
Webinars: Prime Time Conversations and Pathways to PCMH Success, two interactive webinar programs, were broadcast more than 50 times. The
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
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.
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.
12 13
Education & Outreach
January 2012Massachusetts Patient-Centered Medical Home
Initiative, Learning Session 4, Worcester, MA
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
Teaching Track Team Building: Mr. Potato Head
Simulation
Lisa Ogawa, RN, PhD, and Francis Wanjau, MS
March 2012 Academic Pediatric Association Region 1 Meeting,
Sturbridge, MA
Think QuiC! Using Mr. Potato Head to Teach Quality
Improvement
Ronald Adler, MD, and Beth Murphy, MD Hahnemann Internal Medicine Group, Shared Medical
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
Alzheimers Disease
Brenda King, PsyD, LMHC, LCC
Plumley Village Health Services, Worcester, MA
Six-week external program Cooking Matters!
Margaret Apura, MPH, RD, LDN
April 2012Quinsigamond Community College
UMass Memorial Community Relations
Healthy Eating Presentation for ESL students
Margaret Apura, MPH, RD, LDN Clinton Resource Center
Healthy Eating Presentation for parents and families
Margaret Apura, MPH, RD, LDN, and
Lucy Kanjer-Larson, MD
May 2012Rhode Island Quality Institute, Keynote Address
Addressing the Challenges of Practice Transformation
Ronald Adler, MD Belmont Street Community School
UMass Memorial Community Relations
Healthy Eating Presentation
Margaret Apura, MPH, RD, LDN
June 2012Connecticut AHEC, University of Connecticut School
of Medicine and Connecticut Department of Public
Health
Diabetes Care in the Patient-Centered Medical Home
Ronald Adler, MD American Academy of Medical Colleges Workshop
Quality Improvement and Medical Education,
Chicago, IL
Workshop Participant
Judith Savageau, MPH
July 2012High School Health Careers Program
Contemporary and Cultural Health Issues Seminar
Educational Experiences from a Third World
Perspective
Francis Wanjau, MS
August 2012National Night Out
UMass Memorial Medical Center, Worcester, MA
September 2012The Fairbridge Project International/The AIDS Project
Worcester
Healthy Eating Table
Margaret Apura, MPH, RD, LDN Hahnemann Internal Medicine Group
Shared Medical Appointments
Margaret Apura, MPH, RD, LDN, Brenda King, PsyD,
and Janice Polletta, NP
October 2012Worcester Partnership for Quality Elder Mental Health
Care, Worcester Senior Center
Tis Better to Have Loved and Lost: Successfully
Navigating the Waves of Change in Late Life
Brenda King, PsyD UMass Memorial Community Relations
Worcester YWCA
Healthy Eating presentation for teen mothers
Margaret Apura, MPH, RD, LDN
December 2012STFM/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
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.
I chose to practice primary care at UMass Memorial because it feels like a tangible way to serve my community.
Carolyn Keiper, MDPediatric Primary Care Associates,
Worcester
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.
14 15
Janet Hale, PhD, APRN, BC, FNP Associate Dean for Academic Programs, Graduate School of Nursing
Robert Klugman, MD Chief Quality Officer; Medical Director, Managed Care, UMass Memorial
Medical Center
Daniel Lasser, MD, MPH* Senior Vice President, Center for the Advancement of Primary Care;
Chair, Department of Family Medicine and Community Health
Andrew Miller, MD Clinical Chief, Community Internal Medicine
Michele Pugnaire, MD Senior Associate Dean for Educational Affairs, UMass Medical School
Linda Sagor, MD, MPH* Division Director, General Pediatrics
Barbara Weinstein, MBA* Senior Director, Center for the Advancement of Primary Care
Bruce Weinstein, MD Clinical Chief, General Medicine and Primary Care
Lynda Young, MD Division Director, Community Pediatrics
Douglas Ziedonis, MD, MPH Chair, Department of Psychiatry
Jeremy Konstam UMass Medical School student, Class of 2015
Benjamin Vaughan UMass Medical School student, Class of 2015
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.
Primary Care Recruitment and Retention Advisory Group
Julia Andrieni, MD, FACP
Arnold (A.J.) Avila, MEd
William Corbett, MD
Daniel Lasser, MD, MPH
Katherine Pryor
Michele Streeter, CPA
Barbara Weinstein, MBA
With thanks to Lynne Kosloski and Paul Wesolowski for their service during the year.
Center for the Advancement of Primary CareUniversity of Massachusetts Medical School | UMass Memorial Health Care
Organization
Daniel Lasser, MD, MPH Senior Vice President
Barbara Weinstein, MBA Senior Director
Ronald Adler, MD, FAAFP Director, Primary Care Practice Improvement
Margaret Apura, MPH, RD, LDN Dietitian
Brenda King, PsyD, LMHC, NCC Medical Home Care Advisor
Jason Nigrosh, MM Practice Improvement Facilitator
Francis Wanjau, MS Practice Improvement Facilitator
Jennifer Masoud Administrative Assistant
Advisory Committee (*Also serves on the Executive Committee)
Ronald Adler, MD, FAAFP* Director, Primary Care Practice Improvement, Center for the
Advancement of Primary Care
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
Alan Chuman, MPH* Academic Administrator, Department of Family Medicine and
Community Health
William Corbett, MD* Vice President of Community Practices, UMass Memorial Medical Group
Sheila Daly, MS President and CEO, Clinton Hospital
Eric Dickson, MD, MHCP, FACEP Interim President, UMass Memorial Medical Group
Dennis Dimitri, MD, FAAFP* Vice Chair of Clinical Services, Department of Family Medicine and
Community Health
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
16 17
2012 Quality Scholars Program
Graduates
Bronwyn Cooper, MD Assistant Professor, Department of Anesthesiology, UMass Memorial
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
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
Shahrzad Shidfar, MD Assistant Professor, Department of Medicine, UMass Memorial Medical
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
Co-directors
Mitchell Gitkind, MD Associate Chief Quality Officer, Clinical Associate Professor of Medicine
and Surgery
Judith Savageau, MPH Associate Professor of Family Medicine and Community Health
Patient Centered Medical Home (PCMH) Program
Staff and Committee Members
Ronald Adler, MD, FAAFP
Margaret Apura, MPH, RD, LDN
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
With thanks to the following who served during the year:
Arlene Ash, PhD
Alexander (Sandy) Blount, EdD
Amy Finn, PharmD, PhD, MBA
David Keller, MD
Edward Westrick, MD
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*
Hahnemann Family Health Center
Hahnemann Internal Medicine Group, designated as a Level III Patient Centered Medical Home by the
NCQA
Nashaway Pediatrics Clinton
Plumley Village Health Services
*Participants in the Massachusetts PCMH Initiative
Caring for patients always includes listening. The best treatment plan starts with understanding your patient and where theyre coming from.
Kristin Mallett, MDBenedict Family Medicine,
Worcester
Center for the Advancement of Primary Care
55 Lake Avenue North, Benedict Building A3-221
Worcester, MA 01655
Tel: 508-442-7050
[email protected] www.umassmemorial.org/capc