Written by: Center for Care Innovations

Event Materials

Event Booklet
Includes all content for the day, including the speaker biographies for 15 Minutes of PHASE Fame Speakers, our Keynote Speaker Dr. Jamal Rana, and our workshop facilitators.
Main Program Slides
Data Gallery Posters
Charter for Improvement (CFI) Update Template
Workshop Materials: Empanelment for Team-Based Care and Population Health Management, Regina Neal
Workshop Slides
Population Health Management Pyramid & Team-Based Care Worksheets
Workshop Materials: Building Care Team-Patient Communication Skills, Michelle Nanchoff
Workshop Slides
Workshop Materials: Patient Activation: Rethinking Non-Compliance, Juliane Tomlin
Workshop SlidesHandoutsPatient Activation Worksheet – Gallery Walk
PHASE Case Studies
PAM Phases
Patient Activation: ACE Measure Survey – Altarum Institute
Patient Activation: Insignia Health Patient Activation Measure QuestionnaireSupporting Articles

Patient Activation: Hibbard – What the Evidence Shows
Patient Activation: ACE – Validity of a New Patient Engagement Measure


Kaiser Permanente’s PHASE Implementation

Dr. Jamal Rana, MD, PhD, FACC
Chief, Division of Cardiology, East Bay, Kaiser Permanente; Adjunct Investigator, Division of Research, Kaiser Permanente Northern California

A Guy, a Team, a Mission: One Clinic’s Approach to Heart Health

Douglas Frey, FNP
Family Nurse Practitioner, Lifelong Medical Center

From Idea to Impact: Our Congestive Heart Failure Clinic Journey

Joan Singson

Director of Population Health Management, San Joaquin General Hospital

It’s Up to All of Us: Extending the Hypertension Care Team Beyond the Clinic

Bo Greaves, MD
Hearts of Sonoma


Empanelment for Team-Based Care and Population Health Management: Connecting the Dots for Better Patient Engagement

Regina Neal, Qualis Health

Workshop Objectives:

  • Assess empanelment in your practice and identify steps to strengthen your empanelment system
  • Review elements for improved population health management, including empanelment and team-based care
  • Discuss effective strategies to support and engage patients to manage their BP
  • Identify specific areas where your organization can better enable patients to engage as partners in their care to improve BP control
  • Leave the session with at least two action steps to continue the work discussed in the workshop
Workshop Description:

Empanelment enables primary care practices to “change the game” for patients by making access to and continuity with their primary care provider (PCP) and care team possible – key ingredients for successful patient engagement.  In turn, having a defined population of focus enables the PCP and care team to provide the right care to the right patient at the right time. This leads to improved outcomes and improved patient experience – which are also key requirements in a value-based environment.

In the workshop, empanelment expert Regina Neal will review key steps for empanelment. She will also discuss common challenges – and options for solutions – to help organizations continue to pursue empanelment, which offers high value for enabling population health management by care teams.

Using a QI framework, the workshop will assess strategies that care teams can use to support and engage their panel of patients to achieve improved BP control. The session will include opportunities for participants to identify empanelment barriers and “workshop” solutions with Regina and other participants.

Building Care Team–Patient Communication Skills to Enhance Health Outcomes

Michele Nanchoff, Institute for Healthcare Communication

Workshop Objectives:

  • Learn the fundamentals of improved care team-to-patient communications: engaging the person, empathizing with their concerns and situation, educating with clear language using proven strategies, and enlisting the patient as a partner and focus of care
  • Identify the difference between biomedical tasks and communication tasks
  • Practice a key patient education strategy and communication skill
  • Explore ways you can take this new knowledge back to the exam room – and share with colleagues
Workshop Description:

Effective communication between members of the care team and patients yields numerous benefits — from more accurate diagnoses and more engaged patient decision making to improvements in job satisfaction and higher patient satisfaction scores.

Great! Now how do we get there?

Patient-centered communication skills are learnable. This fast-paced, research-based workshop from the Institute for Healthcare Communication will teach you these techniques and strategies – and give you a chance to practice.

Patient Activation: Rethinking Patient Non-Compliance

Juliane Tomlin, Center for Care Innovations

Workshop Objectives:

  • Find out why a “non-compliant” patient might really be an “inactivated” patient
  • Learn how an “activated” patient with the knowledge, skills, and confidence to manage their health and health care can positively impact quality outcomes, cost, utilization, and patient experience
  • Gain skills and tools your care team can use to increase your patients’ activation level for improved hypertension control
  • Find out how to tailor your interventions to a patient’s activation level for optimal efficiency and effectiveness of resources
Workshop Description:

Do you struggle with compliance among your PHASE patients? This workshop will demonstrate a new way to approach these challenges: with the goal of “activating” your patients so that they have the knowledge, skills, and confidence to manage their own health and health care.

Research demonstrates that “activated” patients:

  • Have lower costs and utilization
  • Have increased adherence to treatment plans and medication use
  • Have improved outcomes
  • Use fewer resources
  • Are more likely to benefit from techniques such as health coaching and Motivational Interviewing

Through case studies and hands-on exercises, this workshop will provide tools and insights that you can take back to your team to set your patients up for success—by turning them into “activated” consumers who play a more engaged role in their own health.



Find this useful or interesting? We’re constantly sharing stuff like this. Sign up to receive our newsletter to stay in the loop.