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Project Team


Jonathan Sugarman Jonathan Sugarman, MD, MPH, Principal Investigator, led the Safety Net Medical Home Initiative (SNMHI). Dr. Sugarman is a recognized leader in the area of quality improvement and primary care redesign, and regularly serves as an advisor for government and private sector quality measurement and improvement initiatives. He frequently speaks to regional and national audiences on topics related to healthcare quality and accelerating healthcare transformation through implementation of models such as the medical home.


Edward Wagner Edward Wagner, MD, MPH, MACP, is a General Internist/Epidemiologist and Director Emeritus of the MacColl Center for Health Care Innovation at the Group Health Research Institute. His research and quality improvement work focuses on improving the care of seniors and those with chronic illness. He and his MacColl Center colleagues developed the Chronic Care Model (CCM). The CCM now serves as the foundation for improving ambulatory care for many national and international organizations. Dr. Wagner has written two books and more than 250 publications. He is a member of the Institute of Medicine of the National Academies.


Kathryn PhillipsKathryn Phillips, MPH, directed regional and national patient-centered medical home (PCMH) demonstration projects for Qualis Health, including serving as the Director of the SNMHI. Ms. Phillips developed PCMH transformation resources for practices and practice coaches, and also provided guidance to a variety of clients and stakeholders on PCMH payment policy. Ms. Phillips has experience in public health research, policy and programming; healthcare purchasing and benefit design; and grants management. Prior to joining Qualis Health, she managed education programs for the Center for Prevention and Health Services at the National Business Group on Health, a nonprofit membership organization of Fortune 500 employers.


Diane Altman DautoffDiane Altman Dautoff, MSW, EdD, was a Qualis Health Senior Consultant who focused on leadership engagement and change management related to successful NCQA PCMH™ Recognition and full implementation of patient-centered medical homes. Having spent more than 25 years in the healthcare industry, Diane's experience includes quality improvement, leadership coaching and board development, strategic planning, team building, and facilitation.



Brian AustinBrian Austin is Associate Director of the MacColl Center for Health Care Innovation, which he helped found in 1992. He is also Deputy Director of PCT-LEAP, a Robert Wood Johnson Foundation National Program created to identify and apply innovations in the primary care workforce. He helped develop and refine the Chronic Care Model, a systems approach to improve the delivery of care to the chronically ill, which originated at MacColl and is incorporated into the principles of the PCMH. Mr. Austin is also a member of the leadership team of the MacColl Center's parent department, the Group Health Research Institute, which conducts epidemiologic, health services, and behavioral and clinical research addressing a wide and evolving range of clinical and public health questions.


Katie ColemanKatie Coleman, MSPH, is a Research Associate for the MacColl Center for Health Care Innovation at the Group Health Research Institute. She leads a variety of efforts to improve the quality, equity and long-term viability of primary care in the United States. As part of this work, she participated in the design, development and implementation of technical assistance for the Safety Net Medical Home Initiative. Prior to joining the MacColl Center, Ms. Coleman managed the strategic planning and government grants portfolio for Access Community Health Network, the nation's largest network of community health centers.


Susan CrocettiSusan Crocetti, RN, BSN, CPHQ, CPEHR, HEM, PCMH CCE, has over 20 years of healthcare industry experience, specializing in quality improvement, performance improvement, health information technology, patient safety, risk management and clinical care. This includes work specific to the PCMH Model of Care delivery, with a particular focus on development of PCMH practice readiness tools and completion of PCMH applications for NCQA PCMH Recognition.



Donna DanielDonna Daniel, PhD, led Qualis Health's PCMH measurement and quality improvement programming and was the Practice Transformation and Measurement Director for the SNMHI. She has trained with the Institute for Healthcare Improvement (IHI) with emphasis in quality improvement methodology; registry development; measurement and data tracking; and spread theory.



Sharon ElorantaSharon Eloranta, MD, was Qualis Health's Medical Director for Patient Safety. She provided healthcare quality training and consultation across the country and was a frequent speaker on quality and safety improvement methods. Under Dr. Eloranta's leadership, Qualis Health conducted multiple local, regional and national Breakthrough Series Collaboratives on diabetes care; primary and secondary prevention of cardiovascular disease; prevention of surgical site infections; and nursing home improvement on pain and pressure ulcers.


Bre HoltBre Holt, MPH, is a Program Manager for Qualis Health. She manages a diverse portfolio of projects focused on implementing the Patient-Centered Medical Home Model of Care and expanding the available resources to support practice transformation. Ms. Holt has a diverse background in nonprofit health project coordination, most recently in the field of maternal–child health. As the Project Coordinator for the Business Case for Breastfeeding and the Worksite Lactation Support Program, she worked with federal, state, and local organizations and private entities, planning and managing conferences, workshops, and events; creating materials and webinars; and coordinating teams of professionals to implement change in their communities.


Jeff HummelJeff Hummel, MD, MPH, is a General Internist with experience in primary care and health informatics. Dr. Hummel helped build a start-up delivery system of neighborhood clinics around Seattle-King County, resulting in the area's first electronic medical record system. He specializes in meaningful use, specifically helping practices develop workflows to support the PCMH Model of Care.



Regina NealRegina Neal, MS, MPH, possesses more than 25 years of experience in the healthcare industry, including positions with health plans, public health departments and ambulatory health systems. Regina is well experienced in the areas of the PCMH Model of Care; quality improvement; strategic and business planning; governance; survey research and analysis; and team building and facilitation. She helps clients deliver high quality, patient-centered care throughout their practices, including working with practice teams to reduce cycle times; creating access to appointments; and establishing patient-centered facilities and systems of care.


Robert ReidRobert J. Reid, MD, PhD, is an Associate Investigator at the Group Health Research Institute and Associate Medical Director of Health Services Research & Knowledge Translation at Group Health Cooperative. Dr. Reid is a primary care physician with master's training in public health and doctoral training in health policy and management. His research interests revolve around primary care organization and design, as well as the translation of preventive care research into day-to-day clinical practice.


Nirmala (Nimi) SandhuNirmala (Nimi) Sandhu, MPH, was the Data Analyst for the SNMHI, gathering and analyzing PCMH transformation measurement data. Ms. Sandhu has extensive experience in data management and analysis in healthcare research. Prior to joining Qualis Health, Ms. Sandhu worked at the Group Health Research Institute in Seattle with the MacColl Center for Health Care Innovation as a Programmer/Analyst.



Judith SchaeferJudith Schaefer, MPH, is a Senior Research Associate with the MacColl Center for Health Care Innovation at Group Health Research Institute. There she leads quality improvement projects and directs learning communities on PCMH and complex chronic conditions. Ms. Schaefer develops PCMH transformation resources for practices and coaches and provides expertise on delivery and measurement of patient-centered care, self-management support and care coordination. Ms. Schaefer has been a leader and trainer in helping individuals and systems change for over 15 years, leading quality improvement projects for the Bureau of Primary Health Care and the Institute for Healthcare Improvement.


Nicole Van BorkuloNicole Van Borkulo, MEd, was a Senior Quality Improvement Specialist at Qualis Health. She also conducted training programs for PCMH practice coaches and supported the SNMHI's Medical Home Facilitators. She has more than 10 years of experience in designing and directing healthcare collaboratives.




Karen Vest-TaubertKaren Vest-Taubert, RN, BSN, MBA, PCMH CCE, Six Sigma Green Belt, possesses 20-plus years of clinical and administrative leadership experience in acute, home health, nursing facility and safety net environments. She is currently a senior consultant for Qualis Health, providing technical assistance related to medical home consulting. Prior to joining Qualis Health, Karen served as the chief nursing officer for a federally qualified health center where she managed a PCMH certification project.


Ginny WeirGinny Weir, MPH, was a Program Analyst for Qualis Health who managed education resources. She has experience in education and training materials, as well as literature reviews and policy analysis.