In 2023, our health center embarked on an ambitious four-year Primary Care Team Redesign (PCTR) project. The goal was to reimagine the structure and function of our primary care teams to better meet the needs of our patients, providers, staff, and the broader health system. The project was grounded in the belief that care team redesign, when done thoughtfully, can address systemic challenges in access, quality, and workforce sustainability. Despite a pause in 2025 due to financial constraints, the work completed may offer valuable insights for other health centers navigating similar terrain.

Background and rationale

The PCTR project was formally proposed in early 2023 through a business case presentation that emphasized the need for foundational change in care delivery.1 Key drivers included inadequate access to physician providers for complex care; underutilization of advanced practice providers (APPs), registered nurses (RNs), and medical assistants (MAs) at the top of their scopes of practice; fragmented interprofessional collaboration; rising provider burnout and staff dissatisfaction; and pressures from value-based payment model updates.

From the outset, the project aimed not just to shift structures but to cultivate cultural change, empowering all team members to work at the top of their licenses, expand care access through distributed roles, and reinforce collaboration.

The project was designed to align with our organization’s strategic pillars: Our Customers, Our People, Quality and Excellence of Care, and Sustainability.¹ The business case was grounded in literature supporting team-based care models. For example, optimizing team-based care can improve access and reduce burnout by leveraging the full scope of practice for all team members.² And evidence shows that team-based care models, when implemented effectively, enhance patient satisfaction and clinical outcomes by redistributing workload and reducing clinician burnout.³

The proposal also acknowledged financial risks, especially upfront staffing and training costs, though the long-term benefits — improved performance under value-based contracts, enhanced patient outcomes, and improved provider and staff satisfaction and engagement — were seen as significant. This tension between aspiration and feasibility would become a recurring theme throughout the project and would ultimately contribute to a partial stalling of the work.

Project structure and governance

The PCTR initiative had a defined governance model. I served as the leader of the project, supported by a multidisciplinary core team including a project manager, chief medical officer, physician and APP champions, nursing director, and clinic administrator.⁴ The team developed a comprehensive charter that articulated the project’s objectives, guiding principles, and scope.

The project was divided into five iterative phases: strategic planning, operational design, training and pilot implementation, beta site dissemination, and ongoing monitoring and evaluation. Each phase was designed to build on the last, with feedback loops and stakeholder engagement woven in.⁵

Methodology and process

Early work focused on identifying strategic gaps across four domains: patient experience and access, staff and provider satisfaction, quality of care, and financial sustainability.

These gaps were prioritized using a tiered system (must close, important to close, and nice to close) and corresponding strategies to address them.

To address access issues, the team proposed increasing RN- and MA-only visits, implementing shared panel management, and expanding telehealth flexibility.⁶ Research pointed to benefits of RN- and MA-led visits, such as enabling top-of-licensure work, enhanced access and patient satisfaction, improved physician workload efficiency, and long-term financial sustainability through optimized care delivery.⁷

External consultation helped on goal setting, workflow design, and implementation sequencing, with emphasis on the importance of defining scope, guardrails, and communication strategies early in the process. The team was encouraged to think systemically about how redesign choices would affect the broader care ecosystem.⁸

The project also launched workflow design teams, each with a designated champion and cross-functional membership. These teams were tasked with translating strategic goals into operational workflows, job aids, and training plans.

Redesign work was sequenced into four workflow design “waves” starting in mid-2024, each focused on a distinct cluster of care functions.⁹ This decision was intended to ensure adequate administrative support, reduce scheduling conflicts, and allow for iterative learning across teams. Two additional workgroups — an existing Inbox Management and an EHR Tools workgroup set up from a standing Athena Core Team — were operated as ad hoc resources in support of all waves:

• Wave 1 (May 2024) included launch of the MA-C/MA-R Roles, RN Role, and Panels & Schedules Workgroups.
• Wave 2 (October 2024) launched the BMed Integration, Call Center & Patient Services Representative (PSR) Roles, and Integrated Clinical Pharmacy Workgroups.
• Wave 3 (January 2025) added the New Patient Visits and Discharge & Aftercare Workgroups.
• Wave 4 (not launched at the time of the project pause) was to include Diabetes Education/Outreach and Health-Related Social Needs (HRSN/SDoH) Workgroups.

This phased approach allowed the PCTR Core Project Team to monitor progress, provide targeted support, and adjust timelines based on real-time feedback.

Editor's note: The remainder of this article is available exclusively in the October 2025 issue of MGMA Connection magazine or with member sign-in to this article.