Transforming Your Practice to the Patient-Centered, Advanced Primary Care Model

HealthTeamWorks currently supports the transformation of more than 2,300 medical practices in 18 states through our participation in federally-funded innovation pilot programs and via direct client engagements with practice organizations and integrated delivery networks.

The federally-funded programs include:



HealthTeamWorks Role

Number of Practices

CPC+ National

National Learning Network Facilitation


CPC+ Colorado

Regional Learning Network


CPC+ Nebraska  

Regional Learning Network


Colorado SIM 

Coaching, HIT Support, and Behavioral Health Integration support


Delaware SIM*

Transformation Support 


Colorado TCPi  

Coaching and HIT support


Each federal innovation program implements a distinct change model and criteria for practice and payer participation. Click here for more about our current and past projects.  

HealthTeamWorks also provides consulting and services via direct client engagements with other practices, practice organizations, residency programs and integrated delivery networks. 

We conduct change in practices using are adapted advance primary care model: 

Advanced Primary Care Model Components

The HealthTeamWorks model of Advanced Primary Care Transformation leverages all we learn from our key roles in the federal programs, plus more than twenty years of experience working with practices and providers toward achieving the goals of better quality care, better patient and family experience, smarter spending and healthier communities. 

Practice performance improvement is driven by: 



Volume-to-value through integration is not an overnight shift in culture, process or infrastructure. High functioning networks actively engage patients, align services and resources based on the needs of a risk-stratified population, in addition to coordinating care across settings, optimizing health information technology, integrating services such as behavioral health, and embedding continuous improvement processes. All these pieces come together to drive sustainable change.

 - Kristi Bohling-DaMetz, RN, BSN, MBA, Chief Strategy Officer, HealthTeamWorks




Evaluation Matrix

The support and services that HealthTeamWorks provides for implementing advanced systems of practice include:

  • Practice Performance Evaluation (Advanced Primary Care / PCMH Monitor)
  • Performance Improvement Project Planning (goals, metrics, tasks, tactics, schedule)
  • Leadership Engagement and Team Building
  • Performance Improvement Coaching and Facilitation (in-person and remote services)
  • Collaborative Learning Activity Planning, Implementation and Facilitation
  • Step-by-Step Best Practice Guides, Tools and Template Samples
  • Work Flow Mapping and Implementation Support
  • Practice Team Trainings
  • HIT Optimization
  • Behavioral Health Integration
  • Telehealth Implementation
  • Virtual Collaboration Platform via HealthTeamWorks Solutions Center


Your Partner Of Choice In Practice & Network Transformation

HealthTeamWorks is a well-respected leader in healthcare transformation. With more than 20 years of healthcare transformation experience, our approach fosters sustainable improvement for organizations to succeed in today’s changing healthcare environment, which is becoming more regulated, expensive, and complicated to navigate. We enable our clients to achieve measurable improvements in healthcare delivery through deep client collaboration and a shared commitment to achieve improved patient care, lowered costs, workplace satisfaction, and healthier communities.


Learn More About Our Team