ToolkitsImplementation guides and other documents with extensive resources included

  • Toolkits

    Population Management in Community Mental Health Center-based Health Homes

    This resource provides a nice overview and lays out the principles of population management. Although it is written about community mental health-based settings, the material is relevant to taking a population health approach in primary care.

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  • Toolkits

    Managing Populations, Maximizing Technology Population Health Management in the Medical Neighborhood

    Download a guide to taking a population health approach from this website. While focused on Health IT, there is useful information for supporting a team-based approach to population management in primary care, including a case study of one LEAP site, Union Health Center. Shaljian, M. Nielsen, M. Managing Populations, Maximizing Technology: Population Health Management in the Medical Neighborhood. Patient-Centered Primary Care Collaborative (2013)

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WorkflowTemplates, flow sheets and mapping aids

  • Workflow

    Exception Report Review Calendar

    See the exception reports used by one LEAP site, the Wright Center-Mid Valley Practice in NE Pennsylvania, as part of relentless efforts to "close the loop" on care gaps.

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  • Workflow

    Population Management Weekly Checklist for MA

    This is a tool developed by one LEAP site to help MAs conduct oureach to diabetic patients on their panel. MAs have four hours of protected time each week to conduct outreach to patients.

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  • Workflow

    Diabetic Population Management Checklist

    This is a tool to help MAs conduct outreach to diabetic patients on their panel developed by one LEAP site. MAs have 4 hours of protected time each week to conduct outreach to patients.

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Staff trainingTutorials, training manuals, etc.

  • Staff training

    Population Management: Managing the Logistics for Your Patient Panel

    See the training materials developed by one LEAP site, West County Health Centers, to support their role in population management. MAs have four hours of protected time each week to conduct outreach to patients. This training helps MAs understand the value of this type of work and tips for calling patients.

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