Transforming Clinical Practice Initiative

The Transforming Clinical Practice Initiative (TCPI) model was uniquely designed to support clinician practices through nationwide, collaborative, and peer-based learning networks designed to help clinicians and practices to achieve large scale health care transformation, prepare practices to successfully participate in value-based payment arrangements, including Alternative Payment Models (APMs), and improve the quality of care.

While the four-year initiative has concluded, we are providing access to the tools and resources for clinical practice transformation that emerged from the experience of the TCPI Community of Practice to allow clinicians and practices to consider adopting the principles and strategies that have proven effective in transforming clinical practices nationwide for improved healthcare delivery and patient outcomes.


CMS launched the Transforming Clinical Practice Initiative (TCPI) in 2015 to provide technical assistance to more than 140,000 clinicians (both primary and specialty care) over a four-year period in sharing, adapting, and further developing their comprehensive quality improvement strategies. TCPI created a nationwide, collaborative, and peer-based learning network designed to prepare practices to successfully participate in value-based payment arrangements.

The primary goals of the TCPI were to:

  • Support more than 140,000 primary and specialty care clinicians enrolled in Practice Transformation Networks (PTNs) and (Support and Alignment Networks) SANs to achieve practice transformation, and provide education on the implications of the Quality Payment Program (QPP) for clinicians.
  • Build an evidence base on practice transformation so that effective solutions can be scaled. To achieve this, TCPI was designed to develop, capture, and report a standard set of measures, aligned with the overall goals of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the QPP. Best practices and lessons learned were shared to support practice transformation and practice transitions into alternative payment models.
  • Improve health outcomes, reduce unnecessary hospitalizations, and reduce overutilization of other services for five million Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries and other patients; and
  • Sustain efficient care delivery for Medicare, Medicaid, and CHIP beneficiaries by preparing at least 75 percent of practices that complete the TCPI phases of transformation to move into APMs.

TCPI supported clinicians in transformation over the four-year program period by establishing practice and professional association networks. In addition to the networks awarded for the 4-year program performance period in the sections that follow, the American Psychological Association and Virginia Cardiac Services Quality Initiative (VCQI) received awards from September 2016 to September 2018.

Practice Transformation Networks (PTNs)

PTNs were peer-based learning networks designed to coach, mentor, and assist clinicians in developing core competencies specific to practice transformation. The following 29 organizations were awarded cooperative agreements to serve as PTNs:

  • Arizona Health-e Connection
  • Baptist Health System, Inc.
  • Children's Hospital of Orange County
  • Colorado Department of Health Care Policy & Financing,
  • Community Care of North Carolina, Inc.
  • Community Health Center Association of Connecticut, Inc.
  • Consortium for Southeastern Hypertension Control
  • Health Partners Delmarva, LLC
  • Iowa Healthcare Collaborative
  • Local Initiative Health Authority of Los Angeles County
  • Maine Quality Counts
  • Mayo Clinic
  • National Council for Behavioral Health
  • National Rural Accountable Care Consortium
  • New Jersey Innovation Institute
  • New Jersey Medical & Health Associates dba CarePoint Health
  • New York eHealth Collaborative
  • New York University School of Medicine
  • Pacific Business Group on Health
  • PeaceHealth Ketchikan Medical Center
  • Rhode Island Quality Institute
  • The Trustees of Indiana University
  • VHA/UHC Alliance Newco, Inc.
  • University of Massachusetts Medical School
  • University of Washington
  • Vanderbilt University Medical Center
  • VHS Valley Health Systems, LLC
  • Vizient, Inc.
  • Washington State Department of Health

Practice Transformation Networks


TCPI PTN mapped


Support and Alignment Networks (SANs)

SANs provided a system for development of innovative quality improvement programs and workforce skills building through their existing and emerging assets (e.g., continuing medical education, maintenance of certification core competency development) through utilization of professional associations and public-private partnerships. In addition, SANs supported the recruitment of clinician practices serving small, rural, and medically underserved communities to play an active role in the alignment of new learning. The following 10 organizations were awarded cooperative agreements to serve as SANs:

  • American Board of Family Medicine
  • American College of Emergency Physicians
  • American College of Physicians
  • American College of Radiology
  • American Medical Association
  • American Psychiatric Association
  • HCD International, Inc.
  • National Nursing Centers Consortium
  • Network for Regional Healthcare Improvement
  • Patient Centered Primary Care Foundation

In addition to supporting clinicians and practices enrolled in TCPI, the SANs worked on the following activities to spread best practices and ensure sustainability and diffusion of learning:

Additional information about SAN programs and resources can be found on the SAN web page.

Resources & Support for Undertaking Clinical Practice Transformation

“Thrive in a changing health care system and create a practice that works better for you.”

Throughout the four years of TCPI, a number of resources and tools were identified to support clinicians and practices sustain their transformation and encourage others to begin their transformation journey.

TCPI prepared practices for success in APMs in 8 areas; the first 5 pertain to achieving outcomes to demonstrate model success, while the last 3 pertain to implementing improvements critical to practice success:

  1. Attaining benchmark performance levels on health outcomes and clinical processes;
  2. Avoiding unnecessary use of hospitals and emergency departments;
  3. Avoiding unnecessary tests and procedures;
  4. Lowering total cost of care and producing cost savings for payers;
  5. Benchmarking results on patient experience;
  6. Providing patient- and family-centered care, helping to engage patients in both the care process and the ongoing continuous quality improvement process within practices;
  7. Using continuous, data-driven quality improvement practices; and
  8. Creating sustainable business operations.

Hear from Experts in Clinical Practice Transformation – TCPI National Faculty Alumni

The TCPI National Faculty supported clinicians and practices by sharing their own expertise and experience in transformation, across primary and specialty care settings.

Additional information can be found on the National Faculty Alumni web page.

Get Oriented to APMs

Connect & Learn with Professional Organizations in TCPI

The ten professional associations and public-private partnerships awarded agreements as Support and Alignment Networks (SANs) offer resources and tools to support primary and specialty care clinicians in quality improvement and value-based care delivery, and participation in Alternative Payment Models (APMs).

Additional information about the SANs and their resources can be found on the SAN web page.

Get Started

Test Changes & Monitor Progress

Solve Practice Challenges - SAN Power Packs

The SAN Power Packs are examples of innovative transformational accomplishments at the practice level that address specific, discrete hurdles on the pathway to preparing a clinical practice to adopt an alternative payment model (APM).  The Power Packs address challenges in six core topics for practice improvement:

  • Sustainable Business Operations
  • Person and Family Engagement
  • Joy in Work and Satisfaction
  • Understanding Data
  • Evidence-Based Care
  • Care-Coordination

Additional information about the SAN Power Packs can be found on the SAN Power Packs web page.

Additional Information

For additional information, please contact

You can learn more about CMS' Models by visiting the Center for Medicare and Medicaid Innovation (CMMI).

Where Health Care Innovation is Happening