Category Topics

⭐️ Affinity Groups

See what each of the Affinity Group teams have been working on, as they continue to meet at least quarterly.
6

⭐️ PHLN Activities

Discussions about program-related items, including convenings, site visits, webinars, and more!
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Resource Library

Find all resources from the Forum compiled in one place here!
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Behavioral Health Integration

Information and tools about integrating behavioral health into primary care, covering different models, roles, screening tools, and use of registries to identify and manage patients; monitoring outcomes.
5

Care Management for Complex Patients

Identifying high-risk patients; defining interventions for patients based risk levels; building community partnerships, and managing hospital transitions.
6

Data Governance & Analytics

Data governance, stewardship, and analytic tools. Data visualization and data transparency.
4

Learning Organizations

Understanding adaptive and technical challenges; leading and managing change; communicating around large change initiatives; clarifying leadership roles and how leaders work together to provide integrated care.
1

Planned Care and In-Reach

Gauging patients’ needs and delivering timely services and support before and during the visit, with an emphasis on leveraging technology, data tools for clinical decision making, and patient engagement strategies.
8

Proactive Outreach

Using data and the care team to outreach to patients with care gaps or assigned members that have yet to establish care; examples of outreach strategies including outreach reports.
8

Social Needs

Screening and prioritizing non-medical needs, as well as building internal systems, referral processes, and effective partnerships with community organizations to respond to identified needs.
12

Team-Based Care 2.0

Care team roles and functions; standing orders; protocols and tools to optimize individual team roles; use of alternative visits; reducing variation and promoting standardization of care teams across sites.
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