Deeper Dive: Teams and Systems-based Practice

Dr. Christopher Hanks, MD, Polly Irwin, RN, Dr. Heather Saha, MD

This session will focus on the practice-level application of Core Competency #4, Teams and System-Based Practice, addressing many of the barriers to team-based care, including issues around billing, coding, referring, and coordinating care.

Learning Objectives

After completing this training, attendees will:

• List coding/billing mechanisms to improve care coordination and team-based care.
• Discuss strategies to improve referral and follow up.
• Identify ways to keep patients (and families/guardians as appropriate) informed and aware of referrals, health care records, electronic communication, etc.
• Describe systems of community-based services and supports that may be useful for patients with disabilities outside of the clinical care system. Be prepared to consider cultural factors and interact with these systems and make relevant referrals to ensure comprehensive care coordination, particularly during times of transition.

Presentation