1. Patient Centered Specialty Care Breakout Session Template PCSC Breakout Session - Date

2. Practice Demographics 2 Confidential and Proprietary 1.State: 2.Practice Locations: 3.Number of Physicians: 4.Number of patients served:

3. The Transformation Team 3 Confidential and Proprietary Meeting Times: Team Roles: Insert Team Photo Here

4. Specific Aim 4 Confidential and Proprietary What is your Aim statement? What are you trying to test?

5. Plan 5 Confidential and Proprietary List the tasks needed to execute this test of change. Who were the responsible person(s)? When was the test performed?

6. Plan (continued) 6 Confidential and Proprietary What did you predict would happen as a result of implementing this test of change? List the measures used to track your progress/success.

7. Examples 7 PROPRIETARY AND CONFIDENTIAL

8. Study 8 Confidential and Proprietary Describe the measured results and how they compared to your predictions. What did the practice learn? Was the goal met?

9. Study 9 Confidential and Proprietary Data/Graphs/Charts

10. Act 10 Confidential and Proprietary What did you conclude from this process? What modifications to the plan will be made for the next cycle based on learnings?

11. Key Questions to Answer-Breakout Session #1 11 Confidential and Proprietary 1.How is your practice expecting to engage with your primary care partners to share expectations? 2.How will you communicate care management roles? 3.How will you work with primary care to clarify the reason for referral? 4.What changes will you need to make to your referral process to incorporate the care compact standards? 5.What standards did your practice establish around the care compact? How are they being documented and communicated? o Standards for timeliness: scheduling patient, communicate results o Core data set: are you establishing a core data set or customizing it by condition?

12. Key Questions to Answer-Breakout Session #2 12 Confidential and Proprietary 1.How has your practice created feedback loops or touch points with your referring providers to see how the processes are working? 2.What changes have you made to staff roles and responsibilities to enhance/streamline care coordination processes? 3.What new ways have you leveraged technology (EMR, population management systems) to enhance care coordination processes? 4.What have you done to enhance your pre-visit planning process (e.g. huddles, standing orders)

13. Key Questions to Answer-Breakout Session #3 13 Confidential and Proprietary 1.What are practical next steps to introduce/enhance shared decision-making at your practice? 2.What will you do to implement/improve upon patient self- management support? 3.When would you use decision aids vs. self-management? 4.Who is the best person(s) in your practice to have decision making and/or self management support discussions with patients? What training would they need? 5.What tools/resources/processes do you use/need to provide patient centric care?