On January 31, 2014, the MacColl Center hosted its first Symposium, supported by the Group Health Foundation's Ed Wagner Endowment for Health Care Transformation.  Primary Health Extension Programs: Current Models & Future Directions  featured guest speakers Craig Jones, MD of the Vermont Blueprint for Health, Art Kaufman, MD from the University of New Mexico and Lyndee Knox from the Los Angeles Practice-Based Research and Resource Network. This panel of national experts and a select group of approximately 50 participants worked to draft a framework for a Primary Health Extension Program in Washington State

What is a Primary Health Extension Program and why is it needed?
Primary care in the United States is under enormous pressure to redesign and improve, often with insufficient resources to support this transformation.   In figuring out what works and what doesn’t work, new challenges arise so the job is never done.  Primary care redesign requires commitment to ongoing improvement.  As my third grade teacher told me: “there is always room for improvement.”

Anticipating these challenges, 2010’s Affordable Care Act authorized the creation of a national Primary Care Health Extension Program within each state. The program would deploy community-based Health Extension Agents to act as practice facilitators/coaches for primary care. These agents, also known as “boundary spanners”, would collaborate with primary care and local agencies to address the social and primary determinants of health in the community, strengthen the workforce in primary care practices, and address health disparities.   Extension expertise would meet public needs at the local level.

The health extension center is modelled after the U.S. Department of Agriculture’s Cooperative Extension Program founded over a century ago.  The Victory Garden Program is one of its most popular and well-known programs, with extension agents helping provide seed, fertilizer, and gardening tools to family farmers around the country.

What did we learn during our Symposium?  
Key themes that emerged from this meeting:

  • Practice support is more than just extension agents, it requires a sustainable infrastructure for performance measurement and feedback, convening practices for shared learning, and serving as a repository of tools, resources and solutions for practice transformation
  • It is not just about transformation inside the practice, it is also about linking primary care and community
  • Transformation must include better integration of mental and behavioral health with primary care
  • Aligning stakeholder interests such as professional organizations, hospitals and health plans, is vital and requires a long-term commitment and vision
  • Implementation is not a linear process, there will be many starts and stops and bumps in the road along the way

At the end of the day I said to the group,  “I hope we can all leave this meeting with a sense now that what had seemed improbable is now possible.”

Michael Parchman



  • The primary care extension program: a catalyst for change. Phillips RL Jr, Kaufman A, Mold JW, Grumbach K, Vetter-Smith M, Berry A, Burke BT. Ann Fam Med. 2013 Mar-Apr;11(2):173-8. doi: 10.1370/afm.1495. [Link
  • A health care cooperative extension service:   transforming primary care and community health. Grumbach, K , Mold JW. JAMA. 2009 Jun 24;301(24):2589-91. doi: 10.1001/jama.2009.923. [Link


  • Parchman ML, Noel PH, Culler SD, Lanham HJ, Leykum LK, Romero RL, Plamer RF. A randomized trial of practice facilitation to improve the delivery of chronic illness care in primary care: initial and sustained effects. Implement Science 2013;8:93  [Link]
  • Steiner BD, Denham AC, Ashkin E, Newton WP, Wroth T, Dobson LA Jr. Community care of North Carolina: improving care through community health networks. Ann Fam Med. 2008 Jul-Aug;6(4):361-7. doi: 10.1370/afm.866. Erratum in: Ann Fam Med. 2008 Sep-Oct;6(5): 468. [Link]


  • Craig Jones and The Vermont Blueprint for Health [Link]
  • Art Kaufman’s TED talk on Health Extension Centers [Link
  • Lyndee Knox and L.A. Net Community Health Resource Network [Link]
Event Date: 
Thu, 03/27/2014