Module 1: Implementing Care Compacts to Enhance Care Coordination

The CDT Module 1 online recording library is available to help support practices in meeting their participation requirements. For questions or more information, please email
Module 1 PDSA Submission Instructions  
The Care Coordination section of the scorecard includes a component for engagement and participation in the CDT activities as described in the Learning Collaborative section. To complete Module 1, practices are expected to submit 1 PDSA worksheet focused on care coordination (i.e., enhancing referral process, establishing huddles, utilizing EMR).  
The PDSA worksheet must be fully completed, including results, to receive credit. Click on the link to download a copy of the PDSA worksheet (Blank Template). 

Learning Collaborative Session Recording
Meeting Materials
Module 1 Webinar: Implementing Care Compacts to Improve Care Coordination
This webinar focuses on the implementation of care compacts by the specialty practice to promote effective communication and improve care coordination within the medical neighborhood. Objectives of this module webinar are to understand the components of a care compact, define a good referral, and establish practice specific standards for elements within the compact to support a collaborative approach to providing comprehensive patient care. As of January 1, 2018, CEU and CME credits will be discontinued.
1 hour
Module 1 Instructional Webinar: Recruiting and Engaging Medical Neighbors
(1) Presentation,
(2) Recruiting Worksheet,
(3) Provider-to-Provider Communication Tool
This session focuses on implementation of care compacts within your medical neighborhood and is meant to be a working session. This is a presentation defining characteristics and desired qualities of high-functioning medical neighbors as well as the importance of care compacts. Throughout this Virtual Office Hour, practices explore their medical neighborhood, identify potential collaborative practices to implement care compacts, develop an outreach plan, and discuss potential implementation challenges.
30 minutes
Module 1 Instructional Webinar: Plan-Do-Study-Act (PDSA) Improvement Model
This session focuses on the Plan, Do, Study, Act (PDSA) improvement model. Practices are introduced to the PDSA components and how to utilize these building blocks to conduct small-scale tests of change within your practice. The topics that are covered include determining a patient and family centered area of focus for improvement within your practice, developing an aim statement to support achievement of your goals, reviewing the components and stages of the PDSA model, reviewing a sample PDSA and utilizing the model for improvement as a framework to guide your work.
30 minutes
Module 1 Tools/Resources  
Below are a list tools and resources to improve care coordination within your medical neighborhood. The objectives include defining the components of the care compact, defining a good referral, and establishing practice specific standards for elements within the compact. 
Module 1 PDSA Examples  
How to outreach to Primary Care Providers (PCPs)  
Invitation Letter to Primary Care Partner
Recruiting and Engaging Medical Neighbors Worksheet
Recruiting and Engaging Medical Neighbors Provider-to-Provider Communication presentation
How to develop a streamlined referral process 
Measures to consider: (1) the number of days to send test results to providers, (2) the number of calls received from referring providers for test results, (3) the number duplicate tests/procedures, and (4)the number of cancelations/no shows for appointments from referring providers. 
Referral Process Tools/Resources 
Physician Referral Checklist
Referral Response Checklist
Provider Referral Request Form
Cardiology Referral Preparedness Tool (Blank Template)
Example of Cardiology Referral Preparedness Tool
Endocrinology Referral Preparedness Tool (Blank Template)
Example of Endocrinology Referral Preparedness Tool
OB/GYN Referral Preparedness Tool (Blank Template)
Example of OB/GYN Referral Preparedness OB/GYN
ACP Referral Tracking Guide
How to enhance care coordination through huddles  
Improve Office Efficiency in Mere Minutes video (2007)
Huddle Evaluation Form
Additional Resources  
While many articles have focused on reducing waiting times and delays in primary care, this article focuses on reducing waiting times and delays between primary and specialty care. 
© 2018 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.