Relationships & Agreements

  

     

Referrals and transitions work best when all parties—patients, primary care providers, and consultants—agree on the purpose and importance of the referral, and the roles that each will play in providing care. As close, personal relationships between primary care practices and specialists or hospital staff have become less common, patient-centered medical homes should start conversations with key specialist consultants, hospitals, and community agencies to discuss each other’s preferences and expectations.
 

Key changes, activities, and resources

At a glance

Key changes
#4 Identify, develop, and maintain relationships with key specialist groups, hospitals, and community agencies.
 #5 Develop agreements with key groups, hospitals, and agencies.
Activities
• Complete internal needs assessment to identify key specialist groups and community agencies with which to partner.
• Initiate conversations with key consultants and community resources.
Develop verbal or written agreements that include guidelines and expectations for referral and transition processes.
Resources
• AHRQ white paper describing the concept of a medical neighborhood and guidance for development [PDF]
• Colorado systems of Care/Patient Centered Medical Home Initiative: Colorado Primary Care-Specialty Care Compact [PDF]
• Promising Approaches for Strengthening the Interface Between Primary and Specialty Pediatric Care, from the Federal Expert Workgroup on Pediatric Subspecialty Capacity [PDF]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
More about key changes #4 and #5
 
#4    Identify, develop, and maintain relationships with key specialist groups, hospitals, and community agencies.
Conduct a needs assessment to determine which providers and organizations you make referrals to most often, and begin working to enhance your relationships with their staff.  Focus not just on providers, but other clinical staff, business managers, and administrative staff such as appointment assistants.  In addition to key specialist groups, hospitals, and emergency departments, consider building relationships with:
  • Ancillary services, such as social work, nutrition, physical and occupational therapy, pharmacy, and others
  • Behavior change support services, such as smoking cessation, exercise, weight loss, and other programs
  • Peer support opportunities for patients—and other community resources patients suggest
 
#5   Develop agreements with these key groups, hospitals, and agencies.
It may take time and several conversations to a build relationship and develop a service agreement, so it’s best to work with one or two organizations at a time.  Be sure the conversations focus on common goals—and on the system, not the people.  Expectations that should be covered in the agreement include:
  • Which patients are appropriate to refer.
  • Information needed before a referral, such as records or test results.
  • Information needed after the consultation.
  • Roles for both parties after the consultation.
  • Any other relevant expectations, such as whether it’s okay for a specialist to refer a patient to another specialist.

Learn More

  • Download the complete toolkit [PDF]
  • Read the AHRQ white paper about medical neighborhoods [PDF] 
  • View an example agreement: Colorado Systems of Care/Patient Centered Medical Home Initiative: Colorado Primary Care-Specialty Care Compact [PDF]
  • View a report on Promising Approaches for Strengthening the Interface between Primary and Specialty Pediatric Care, from the Federal Expert Workgroup on Pediatric Subspecialty Capacity [PDF]
  • Case studies on developing linkages and agreements with specialty groups and community resources: