CCM Health Coaching Integration to Practice Workflows – Traditional Model Identify Practice Contact for Health Coaching Recommend Health Coaching to Patients Flagged with Info Sheet Primary Provider Review weekly Patient list from Health Coach, confirm for CCM Health Coaching Practice Contact Create Practice-specific Patient Coaching Info Sheet and Follow-up Letter Confirm or establish weekly handoff of Patient list with Practice Contact ID CCM Health Coaching patients using claims & EMR w/ appts next week Hand off weekly CCM Health Coaching Patient list to Practice Contact Flag appts for Provider to reco Health Coaching with Info Sheet Mail Physician Follow-up Letter and Brochure to Patient Health Coach Submit claim to Billing Document patient’s results & complete Physician report in Cerner tool Provide ongoing health coaching sessions Conduct Patient assessment at Patient’s home, schedule next appointment Make intro call to Patient, gain verbal consent, schedule assessment