Population Health Management in the Medical Neighborhood

The PCPCC recently released a new report that supports primary care clinicians in their efforts to adopt a population health management (PHM) approach that effectively leverages health IT solutions and community partnerships in the larger 'medical neighborhood.' The webinar features a presentation from Jaan Sidorov on the essential features of health IT-enabled PHM, and Robert Fortini's success at Bon Secours Virginia Medical Group, a Shared Savings ACO in Richmond, Virginia.

Building a Statewide PCMH Program: Design, Evaluation Methods, and Results

Overview of Blue Cross Blue Shield Michigan's statewide patient-centered medical home program, including the history of the program, its PCMH-designation scoring process, evaluation methods, and latest results.

Shining Through Health IT

As the incredible work of the Office of the National Coordinator’s (ONC) national Beacon Community Program wraps up this fall,  Janhavi Kirtane from the ONC, and representatives from Beacon communities around the country tshare their lessons learned and how their achievements will shape future directions and community collaborations. The presentation also provides an overview of their new learning guide that distills the experiences and lessons learned from Beacon Communities, such as goal-setting, community engagement, technology investments, and quality measurement. 

Bringing it Home with the PCMH

As patient-centered medical homes continue to offer the promise of improved patient outcomes, innovators are looking for better ways to leverage the medical neighborhood and coordinate care across settings. During this webinar, participants will hear from leading experts about managing chronically ill populations, including the frail elderly, and engage in discussions about the role of home health care in partnership with the PCMH.

Behavioral Health Integration in the Medical Home

Sponsored by the PCPCC's Behavioral Health Special Interest Group, this webinar features The Massachusetts Patient Centered Medical Home's Behavioral Health Integration Toolkit, which is used by practices to integrate behavioral health into the primary care setting. Participants learn about the processes necessary to develop an integrated care model, and how to use the online tools developed by experts in Massachusetts.

In Search of Joy in Practice: Innovations from 23 High-Performing Primary Care Practices

This webinar describes innovations that can increase physician’s work-life satisfaction, attract future physicians to the field, and improve the quality of patient care authors.  In research sponsored by the American Board of Internal Medicine Foundation and published in the Annals of Family Medicine investigators sought to identify challenges facing primary care practices and innovations that could facilitate and restore joy in practice.  Chief among the innovations is a movement from a physician-centric model of work distribution to a shared-care model with higher levels of clinical suppo

Change Agents in Action: Lessons Learned from Leading Primary Care Practice Facilitation Programs

This webinar, sponsored by PCPCC's Outcomes & Evaluation Stakeholder Center, focuses on "Lessons Learned from Leading Primary Care Practice Facilitation Programs" and feature leading experts in primary care facilitation: David Meyers, MD, Director, Center for Primary Care, Agency for Healthcare Research and Quality; Ann Lefebvre MSW, CPHQ, Associate Director, North Carolin

Meeting Patients Where They Are: A Medical Home Model for High-Risk Patients

Offering a variety of perspectives from patients, care team, and facility staff, this webinar will highlight a medical home model from Seasons of Maplewood in Minnesota that provides team-based, relationship-centered, on-site primary care for over 3,000 high-risk patients. The model emphasizes the coordination of care among primary care practices, assisted living, and group home facilities, and their use of an innovative communication portal to enhance workflows, order entry, and open communication.

Mobile e-Visits in the Medical Home: Implications of a New Delivery Model

Presented by MeVisit and the PCPCC's Care Delivery and Integration Stakeholder Center, Dr. William Thornbury, a Kentucky primary care physician, presents his 2-year research findings on mobile e-Visit technology within the medical home. This webinar discusses the ramifications of true mobility in patient care and the $29 billion implications in every aspect of the healthcare system, including employers, hospitals, insurers and governments.

Easing the Transition: Core Principles and Values for Building Effective Care Teams

An essential element of the primary care medical home is ensuring that providers take a ‘whole-person’ approach to care that meets each patient’s physical and mental health care needs, including prevention, wellness, acute and chronic care. This requires building a team of care providers around a patient that may include physicians, mental health, advanced practice nurses, pharmacists, nutritionists, care coordinators, and social workers.


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