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Elements of Practice Transformation

The Pathway to Practice Transformation, made up of the 10 Elements of Practice Pransformation, is the backbone of our work. These elements are based on the Change Concepts for Practice Transformation, which we co-developed as part of the Safety Net Medical Home Initiative.

The Change Concepts for Practice Transformation have been used by thousands of providers nationwide, from individual practices to large healthcare organizations.

Our experts will guide you through the Elements of Practice Transformation, providing the resources you need to engage your team for success:

  • Specific goals and the steps to achieve them
  • Real-world examples of transformation strategies
  • Tools to customize and use in your own practice
  • Tips for troubleshooting

Engaged Leadership

Develop leaders within your organization who can guide and support the transformation process. Involve staff across all levels, create a culture of quality and engagement, and commit the time and resources needed to ensure success.

Quality Improvement Strategy

Adopt a formal, sustainable approach to continuous quality improvement that includes trusted performance measurement, a strategy for change, and meaningful involvement from patients, families and staff.

Health IT

Leverage health information technology in ways that support your quality improvement strategy and enable you to provide care that is consistent with proven clinical guidelines.


Build population health management capacity by linking each established patient to a personal provider and care team.


Create a culture and systems that ensure patients are able to see their personal provider and care team whenever possible.

Team-Based Care

Structure and deploy care teams strategically in order to meet the unique needs of your patient population. Balance physician workload by maximizing use of team members’ skills, abilities and credentials.

Organized, Evidence-Based Care

Use planned care that is based on scientific evidence in conjunction with proactive outreach so that all patients—especially high-risk patients—receive the right care at the right time in the right place.

Patient Engagement

Empower patients to take an active role in their own care by communicating with them in a language and at a level they can understand, and by helping them develop and meet self-management goals.

Enhanced Access

Provide established patients with 24/7 access to their care team via phone, email or in-person visits.

Care Coordination

Ensure safe and timely care transitions by supporting patients when they receive care from other providers, and by establishing relationships with those providers.