Why use this guide

Better care experiences, better population health, lower cost, and happier staff.

Primary care practices are achieving this quadruple aim by creating more effective practice teams and becoming certified as Patient-Centered Medical Homes. The Primary Care Team Guide provides step-by-step direction on how to establish these high-functioning teams and implement new functions essential to team-based care. Numerous tools and resources from 31 exemplary practices nationwide are made available to support you.

Featured Resources and Modules

Physicians share their experience with team-based care.

Creating a culture of trust and shared responsibility is the foundation, say physicians.

The result is grateful patients and staff, and better care. Team-Base Care: The Physician Experience Video

Create care team flexibility through the use of “flow staff.”

Creating flexibility within team roles can help patients feel like there is a team dedicated their care. See how Family Care Network engages clinical assistants in more flexible support roles to give physicians more time to see more patients.

The Medical Assistant (MA) module

Integrating behavioral health services greatly improves patient outcomes

CareSouth Carolina reports on how it co-located Licensed Independent Clinical Social Workers with primary care teams—and collected data to track its goal of reaching 0% disparities.

Behavioral Health Integration module