The High Value Care Coordination (HVCC) Training is designed to help primary and specialty care practices move from disconnected to connected care.
By strengthening processes related to referrals and care coordination, practices will be able to deliver more efficient, effective and patient-centered care, while also reducing burden on their own care teams.
These materials were developed for practices and Quality Improvement Advisors taking part in the ACP SAN’s HVCC Training. However, any practices interested in transitioning their care model are invited to explore and implement these resources.
The training consists of four Action Steps. Each Action Step has practical, easy-to-use resources associated with it. Most of the documents under each Action Step were referenced in the training. Other documents are additional examples of materials mentioned in the training.
Action Step 1: Get Your Own House in Order
Documents:
- Primary Care Checklist for Referral Process Assessment and Critical Elements
- Specialty Care Checklist for Referral Process Assessment and Critical Elements
- Sample Policies and Procedures for Referral Content
- Sample Referral Policies for Primary and Specialty Care
Foundational report for the High Value Care Coordination curriculum with many good examples cited in the Addendum.
Powerpoint Slide Decks:
- Action Step 1 - Generic
- Action Step 1 - HealthVisions Delmarva
- Action Step 1 - Great Lakes
- Action Step 1 - Vizient
- Action Step 1 - MidSouth
- Action Step 1 - Compass
- Action Step 1 - QIN QIO
- Action Step 1 - QualityImpact
- Action Step 1 - CTC RI HVCC Assistance Program
- Action Step 1 - ARcare
Webinar Recordings:
Action Step 2: Get What You Need for a High Value Referral
Documents:
- HVCC Checklist for Developing Pertinent Data Sets / Referral Guidelines
- Pertinent Data Sets
- Outpatient Referral Request Checklist
- HVCC Pre-Consultation Review Checklist
Powerpoint Slide Decks:
- Action Step 2 - Generic
- Action Step 2 - HealthVisions Delmarva Part 1
- Action Step 2 - HealthVisions Delmarva Part 2
- Action Step 2 - Great Lakes
- Action Step 2 - MidSouth
- Action Step 2 - Compass
- Action Step 2 - QIN QIO
- Action Step 2 - QualityImpact
- Action Step 2 - CTC RI HVCC Assistance Program
- Action Step 2 Office Hours - CTC RI HVCC Assistance Program
- Action Step 2 - ARcare
Webinar Recordings:
- Action Step 2 - HealthVisions Delmarva - Part 1
- Action Step 2 - HealthVisions Delmarva - Part 2
- Action Step 2 - MidSouth
- Action Step 2 - Compass
- Action Step 2 - QIN QIO
- Action Step 2 - QualityImpact
- Action Step 2 - CTC RI HVCC Assistance Program
- Action Step 2 Office Hours - CTC RI HVCC Assistance Program
- Action Step 2 - ARcare
- Action Steps 1 & 2 – UConn
Action Step 3: Ensure Others Get What They Need
Documents:
- Recommendations for a Patient-Centered Referral
- Outpatient Referral Response Checklist
- Referral/Response Audit Sample 1
- Referral/Response Audit Sample 2
- Patient Experience Survey for Specialist Referral
- Patient Experience Survey - Short
- Close the Loop Form
- Template for "One Pager” Info Sheet for Patient on Referral to Specialty Care
Powerpoint Slide Decks:
- Action Step 3 - Generic
- Action Step 3 - HealthVisions Delmarva
- Action Step 3 - Great Lakes
- Action Step 3 - MidSouth
- Action Step 3 - Compass
- Action Step 3 - QIN QIO
- Action Step 3 - QualityImpact
- Action Step 3 - CTC-RI HVCC Assistance Program
- Action Step 3 Office Hours - CTC RI HVCC Assistance Program
- Action Step 3 - ARcare
- Action Steps 3 & 4 – UConn
Webinar Recordings:
- Action Step 3 - HealthVisions Delmarva
- Action Step 3 - Great Lakes
- Action Step 3 - MidSouth
- Action Step 3 - Compass
- Action Step 3 - QIN QIO
- Action Step 3 - QualityImpact
- Action Step 3 - CTC-RI HVCC Assistance Program
- Action Step 3 Office Hours - CTC RI HVCC Assistance Program
- Action Step 3 and 4 - Emory - Grady
- Action Step 3 - ARcare
- Action Step 3 and 4 - UConn
Action Step 4: Create a Care Coordination Agreement
Documents:
- Outpatient Primary Care-Specialty Care Model Care Coordination Agreement
- Primary Care-Hospital Care Model Care Coordination Agreement
- Colorado Springs Primary Care – Specialty Care Compact
- Mesa County Physicians IPA Care Coordination Agreement Referral Form
- Actual Care Compact Example
Powerpoint Slide Decks:
- Action Step 4 - Generic
- Action Step 4 - Great Lakes
- Action Step 4 - HealthVisions Delmarva
- Action Step 4 - MidSouth
- Action Step 4 - Compass
- Action Step 4 - QIN QIO
- Action Step 4 - QualityImpact
- Action Step 4 - ARcare
- Action Steps 3 & 4 – UConn
- Action Step 4 - CTC-RI HVCC Assistance Program
- Action Step 4 Office Hours - CTC-RI HVCC Assistance Program
Webinar Recordings:
- Action Step 4 - Great Lakes
- Action Step 4 - HealthVisions Delmarva
- Action Step 4 - MidSouth
- Action Step 4 - Compass
- Action Step 4 - QIN QIO
- Action Step 4 - QualityImpact
- Action Step 3 and 4 - Emory - Grady
- Action Step 4 - ARcare
- Action Step 3 and 4 - UConn
- Action Step 4 - CTC-RI HVCC Assistance Program
- Action Step 4 Office Hours - CTC-RI HVCC Assistance Program
Video Clips
Action Step 2
- Segment 1 - Referral Request | Download Related Slides
- Segment 2 - Referral Criteria | Download Related Slides
- Segment 3 - Preconsult Process | Download Related Slides
Action Step 3
- Segment 1 - Patient Needs | Download Related Slides
- Segment 2 - Meet Needs of Requesting Practice | Download Related Slides
- Segment 3 - Appropriate Secondary Referrals | Download Related Slides
Action Step 4
General Resources
ACP and the MidSouth PTN Discuss Successful High Value Care Coordination Project - The MidSouth Practice Transformation Network engaged ACP to teach the High Value Care Coordination (HVCC) curriculum to its practice advisors. In this podcast, ACP SAN and MidSouth PTN members discuss the importance of high value care coordination to value-based reimbursements and the impact the ACP SAN’s toolkit and training had on MidSouth’s practices. Featured from ACP are HVCC faculty members Dr. Carol Greenlee, endocrinologist and ACP member, and Beth Neuhalfen, Program Administrator of Health Neighborhood with Denver Health, as well as Cheryl Rusten, Manager, Grants Programs and Administration in ACP’s Medical Education Division.
QIA Tracking Sheet - QIA tracking sheet for High Value Care Coordination pilot to be sent quarterly.
For more information about this HVCC Training course, contact the ACP SAN at SAN@acponline.org.
More High Value Care Resources from ACP
- High Value Care Main Page
- High Value Care Cases (CME and MOC available)
- HVC Pediatric Cases (CME and MOC available)
- Curriculum for Educators and Residents
- Curriculum for Students
- Curriculum for Subspecialty Fellows