Value-based Care:
The Role of Teams

Caring for patients with complex needs

Stacey Bartell, MD 

Developed in collaboration with UCSF Center for Excellence in Primary Care (CEPC) and AAFP.

Upon completion of this session, you should be able to:

• Define Complex Care Management (CCM)
• Describe how the population served by a CCM program will influence its core components and staffing
• Identify metrics used to evaluate the success of a CCM program
• Describe team-based approaches to support patients with complex medical or psychosocial needs

UCSF Center for Excellence in Primary Care (CEPC) and AAFP.

Upon completion of this session, you should be able to:

• Define patient & community engagement in healthcare
• Describe practical approaches to engage patients as partners in practice improvement
• Explain how to translate patient feedback into sustainable improvements in care

Foundations of team-based care

Stacey Bartell, MD
0.25 Credits

Upon completion of this session, you should be able to:

• Define team-based care and its core components (e.g., roles, responsibilities, communication, collaboration).
• Analyze the potential benefits and challenges of implementing team-based care.
• Identify opportunities within your practice to incorporate team-based care principles.

From Tension to Teamwork: Building Bridges between Family Physicians and Health System Leadership for Enhanced Patient Care

Melissa Gerdes, MD, MBA, FAAFP, ABFM, CHCQM
0.75 Credits

Upon completion of this session, you should be able to:

• Develop, initiate, and maintain open communications with health system leadership
• Develop strategies to focus and magnify communications with health system leadership on the needs and perspectives of patients and family physicians
• Identify, understand, and appreciate the responsibilities, perspectives, and challenges of health system leadership as they pertain to primary care practices
• Examine ways to leverage health system resources and support structures to improve the physician and patient care delivery experience

Leading Effective Teams

Jason Marker, MD, MPA, FAAFP and Erin Fajen, Med
0.75 Credits

Upon completion of this session, you should be able to:

• Review how different challenges in the workplace impact leading teams effectively.
• Explore four key strategies and common tactics for leading effective teams.
• Apply information about leading effective teams to their own workplace.

Partnering with Members of your Team

Stacey Bartell, MD
0.25 Credits

Upon completion of this session, you should be able to:

• Define the role of LSM in team-based care.
• Employ active listening and effective communication skills to engage with different care team members.
• Describe approaches to enhance team communication such as effective meetings, huddles, team-building exercises, co-location.

Transformational Leadership

Timothy L. Switaj, MD, MBA, MHA, CPE, FACHE, FAAFP
0.50 Credits

Upon completion of this session, you should be able to:

• Effectively set and communicate your vision for ongoing change.
• Develop leadership skills to advocate for and lead process changes that support advanced team-based care.
• Evaluate challenges to adopting change management principles, including organizational resistance and workflow adjustments, and strategize solutions to overcome these barriers.

Who’s on Your Team? Understanding Job Roles and Expanding Your Impact

Stacey Bartell, MD
0.50 CME credits

Upon completion of this session, you should be able to:

• Explore how team roles may be redesigned to meet the needs of patient populations.
• Discuss how to support staff taking on new roles.
• Appraise evidence and case examples of effective collaboration and roles on the care team to improve patient management and outcomes.