Patient Partner Welcome Package

Use these materials to help you shape the messages, instructions and expectations as you orient your new patient partner to the IBH-PC Quality Improvement Team. Share your final edited patient partner welcome package with all team members to help shape their expectations for partnering with patients on the IBH-PC quality improvement efforts.

Copy/paste whatever content you wish to use from these templates

PP Welcome Letter

(Name of Clinic- Please use your own Clinic Letterhead)

(Date)

Dear (name of partner),

Welcome and thank you so much for deciding to join our team as we begin our work on the Integrating Behavioral Health and Primary Care Initiative (IBH-PC-I).

All of us at (name of clinic) are very grateful that you have allowed us to care for (you and/or your family member/s) and are willing to share the knowledge you have gained from the challenges and rewards of your healthcare experiences. We want you to know how valuable it is that you will be able to join us in this new role to provide the patient perspective and your own expertise from managing your health conditions (or those of a family member).

Please don’t hesitate to call or email (Name of Patient Partner Liaison) with questions or concerns. S/He can be reached at (contact info) should you need any assistance.

Again, thank you so much for joining our team! We look forward to working with you and learning together as we make improvements that will benefit all of our patients.

Sincerely,

(Signature of Clinical Leader)

(Signature of Patient Partner Liaison)

(Names of other IBHPC team members already identified)

PP Checklist

Hi (name of Patient Partner). We have provided the following checklist to help you with a few tasks necessary before we can begin working together. Please read through the entire checklist first, to be sure all tasks are clear. Contact (name of PPL) for any questions or concerns. Then use it to keep track of your progress as you complete each task. Please don’t hesitate to contact (name and contact info of PP Liaison) for any assistance you need.

Carefully review all of the information provided in this Welcome Package:

❑ An overview of the IBHPC-Initiative

❑ Terms of Our Agreement (signature and contact info required)

❑ Confidentiality Agreement (signature required) (alternatively, you may wish to deliver this in person during an orientation and HIPAA training session)

❑ Payment Invoice (details and signature required)

After reviewing these materials, please:

Call or email (name of PP Liaison) to:

□ Please reply promptly to this email to let us know:

• Your final decision about joining the team

• That you were able to open and view all materials

• Your preferred method of contact for receiving materials and scheduling information

• Time of day and days of the week you are available for a Clinical Practice Tour and Orientation

□ Please return the following signed document/s by (date):

□ Terms of Agreement

□ Confidentiality Agreement

□ Invoice for payment

Once we have received your confirmation call/email and received all of your signed documents, you will receive an email from (name of PP Liaison and contact information/email address) with your Orientation details. (Specify whether it will be an in-person session or an online/phone/virtual session)

Please check your spam or junk email folder if you do not receive an email from us. That email will include:

• Invitation with date and time of your Orientation session

• Location, directions and parking instructions

• Materials required for you to read before you come.

Once again, thank you for choosing to partner with us! We ask that you reply promptly to this email to confirm the above items.

□ Please call (name of PP Liaison) to address any technology assistance you require

□ Please take a moment to celebrate! We are so glad to have you on our team and look forward to meeting and working with you soon!

Overview of the Initiative and Educational Program

The “Integrating Behavioral Health and Primary Care” Initiative (IBH-PC) will be a long term improvement effort by our clinic to improve the care we provide for our patients. We are calling it an “Initiative” because it is just a start at making changes to our practice. The “Initiative” will be carried out in three carefully organized stages. We hope these deliberate and thoughtful steps will make our team’s efforts more successful and have greater results for our patients as well as our practice members. For these first stages, we will be focusing on improving care for patients who experience chronic, complex and multiple health conditions.

Here is a description of each of the three stages:

Stage 1: Planning – This team will create a patient centered vision of IBHPC. They will define the amount of change needed using assessment tools and making decisions about next steps.

Estimate of time for Stage 1: 1-3 months @ 8-24 hours total

Stages 2 & 3: Design and Implementation – This team will design how the practice’s operations will change based on the vision plan created during Stage 1 and how those changes will affect patients' care. It will also trial those changes in small, rapid cycles to study and refine them so that they are most effective for patients.

Estimate of time for Stages 2&3: 3-6 months @ 12-40 hours total

How Team Members Will Participate:

Meetings will be led by a facilitator who will guide us through team based activities that help us focus on what is most important to patients when integrating behavioral health into primary care. All meetings are estimated to occur once per week and for no more than 2 hours per meeting. You will be informed of any changes in schedules with plenty of notice. We will not ask you to attend any extra meetings unless they are relevant to this project. You will not be expected to attend meetings if you are in poor health or your health is at risk.

Training and Education of new team members:

All new members of our team are provided basic privacy training required by law. This training involves understanding the rules for healthcare confidentiality, ethics, and privacy. This short training will include basic information about the Health Insurance Portability and Accountability Act (HIPAA) and Protected Health Information (PHI). (Include any other required health or confidentiality education details)

To preview this training please go to the web address provided below. (include this link in the PP Welcome Package materials only if you plan for the PP to do this training independently. Alternatively, you may wish to provide HIPAA training during the PP Orientation session)

http://www.prohipaa.com/en/training_video/what-is-hipaa

IBHPC Initiative Educational Program:

Because the Initiative holds many brand-new changes and challenges for our medical professionals, we have been provided an educational program of courses designed to help us integrate behavioral health in the best way possible for patients.

Arizona State University, the University of Massachusetts and the University of Vermont worked together to develop the IBH-PC Initiative Educational Program consisting of around 80 online courses that cover topics ranging from clinical management strategies to new ways for medical providers to talk with patients when discussing their health conditions.

Do patient partners have to take all 80 courses?

Absolutely not!! We suggest asking your PPs to complete Five Introductory Interprofessional Courses, so your team can “start on the same page” and with the same goals. Each of these 5 online courses takes approximately 1⁄2 hour to complete using a computer, laptop, tablet or smartphone. They can be easily completed at home or a library, as long as they have a stable internet and either headphones or speakers to both hear and view the materials. Each course is very user friendly and involves reading slides, listening to audio files and watching short videos. The total number of hours to complete all 5 courses is estimated at 3-6 hours and can be completed all at once in a day or over several days depending on your PPs learning style and time available. Some team members may do them on their lunch hour, others may choose to do them together as a group or at home after work.

These courses are free and PPs may find them very interesting. You can inform PPs that they are more than welcome to take as many courses as they wish but are only required to complete the 5 introductory interprofessional courses.

Will PPs be graded on this education? Learners will not be graded or required to take quizzes.

This education should prove interesting and informative for all members of your initiative team. (Instructions for how Patient Partners can access the Educational Materials are included in the Welcome Package)

Terms of Our Agreement

(Please include your clinic’s letterhead)

Our Partnership

This partnership represents a new goal for our medical practice. We will learn together as we go about how to partner together successfully on our quality improvement efforts.

Roles:

Our role will be to learn from your patient perspective and experience. Your role is to bring forth the views, opinions and expertise that come from being a patient in our practice.

Responsibilities:

Our responsibility will be to support your full participation on the team and seek your understanding of the changes we are planning. Your responsibility will be to:

• Be available to provide your feedback, insight and expertise on our work,

• Present the patient perspective on how you and your family have experienced care

• Communicate needs that reflect what matters most to patients, family care partners and community members

Respect

You will be an equivalent and respected member of our team. Your voice and views will be heard and valued equally as other members of the team. You will not be considered an employee but we consider you an adviser or consultant who has joined our working team to share expertise you have gained from your healthcare journey. What you share may significantly help us improve how we care for all patients.

Decision making will be made as a group. Team members will make recommendations, placing the needs of all patients first as we work together. We will listen and learn from each other as we go. We will work together to discover, design, and decide on the best ways to safely and successfully integrate behavioral health care into our practice. Our goals are to improve care for all of our patients who may benefit from these services.

Requirements of all team members:

• Attend all orientation sessions and HIPAA training if new to the team

• Attend scheduled team meetings

• Participate in all team activities including on-line educational curriculum.

• Have access to a reliable computer and stable internet

• Have the necessary computer skills to receive emails, do online searches, and access online educational content.

• Keep confidential any information discussed during team meetings

• Respond promptly to emails, phone calls or other requests.

• Allow reasonable flexibility for changes in time or schedules as the Initiative team requires.

• Participate as fully as possible without risking your health.

Resources

We will provide all necessary training, education and technology support needed so that you can participate fully on the team. A Patient Partner Liaison has been assigned to support you and be available for personal guidance during the Initiative. (*If technical help is needed please contact (name of person in charge of tech support.)

Level and Method of Compensation

Because we value your time and understand that it will involve time, effort, and energy to participate fully on the team, you will be compensated for your participation. You will receive a payment of up to (include maximum amount of compensation). This amount is based on a ($x per hour) of scheduled meetings attended and time spent outside of meetings on orientation, education or debriefings. This payment amount is intended to cover travel, parking and daycare expenses during your term on our Initiative team.

Should Changes Arise in Your Ability to Participate

We are committed to creating an enriching and positive experience for all team members. We would like you to commit to this as well. If at any time, you have concerns or if your level of commitment changes, please contact your Patient Partner Liaison for assistance.

We understand that an individual team member’s health comes first before we can help others. Should any challenges arise in your ability to participate, we will work with you to make sure your experience remains successful for you and for the entire team. Your participation will never negatively affect your trusted and established relationships with providers at this clinic or the quality of care you receive. You and the IBH-PC team can reassess at any time. If your participation must end due to unresolvable challenges, again, this will never negatively affect our patient/provider relationships or the quality of care you receive. Your health and wellbeing are always our number one priority.

If you have read and can agree to the terms of this letter, please sign below. Please return to (Include specific instructions for returning all documents). If you have questions or need any assistance before signing, please contact (name of patient partner liaison at #phone number)

I agree to my role, responsibilities, and to the requirements stated in this document during my participation on the IBH-PC Initiative Team and can genuinely commit to do my best to comply with them always. If any concerns or need for assistance arise I will contact the Patient Partner Liaison as soon as possible.

_{Patient Partner signature Practice Team Leader signature}

_{________________________________ __________________________________________}

_{Date: Date:}

_{________________________________ __________________________________________}

Patient Partner Contact Information

Just a few more steps before we can celebrate our partnership! Once you have read and agreed to the terms of our agreement please take a few moments to provide the following information for our paperwork.

Please provide the following methods for contacting you between meetings. Contact info: (Please number each in order of your preferred method of contact)

Email

Home Phone (landline)

Work

Cell

Mailing Address

Please list

1st Emergency contact name:

1st Emergency contact phone number: work: home: cell:

2nd Emergency contact phone number: work: home: cell:

Other details that would be helpful for us to know about best ways for contacting you:

Please add details about any other important participation limitations or details that would be helpful and important for us to know about:

We want to thank you again for agreeing to be a member of our team. We look forward to seeing you soon and beginning our work together to improve care for patients! Please call (name and phone number of PP Liaison) for any information you may need to confirm your participation. Any and all questions are appreciated and are understood to be a part of the process for making your decision and a well-informed commitment to our team.

Sincerely Yours,

(Name of IBHPC Team Leader)

Contact info

(Name of Patient Partner Liaison)

Contact info

Patient Partner Sample Invoice

Patient Partner Name

Address/Phone

BILL TO

Clinical Site Name

Address

DATE

MONTH

YEAR

ACTIVITY

TOTAL HOURS

RATE AMOUNT

Patient Partner Sample Honorarium Letter

[Date]

Dear [Name of recipient],

Thank you for accepting our invitation to join the Integrated Behavioral Health and Primary Care Initiative team at the (name of clinic from mm/dd/yyyy] to [mm/dd/yyyy]. Your activities will include [participating in all meetings and all team activities such as education and training]. We would like to offer you an honorarium of $[amount]. [If applicable:] Also as agreed, (name of clinic) will reimburse your expenses related to this event up to $[amount]. All reimbursable expenses must be documented with receipts.

If the information contained herein is accurate and satisfactory to you, please sign below and return a copy of this letter with the Form W-9 which can be found at the following link: http://www.irs.gov/formspubs/index.html

Please be aware that an honorarium paid to a foreign national is subject to U.S. federal withholding tax of 30%. Payment may be exempt from withholding only if there is a tax treaty benefit between the United States and the foreign national’s country, and a Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) is needed in order to receive the tax treaty benefit.

Thank you in advance for your attention to this matter. Should you have any questions, please call [Name of person who can assist recipient] at [Contact phone no] or email at [email address].

[Department’s closing paragraph]

Sincerely,

[Name & signature of chair/director]

By my signature, I [Name of recipient], hereby certify that this honorarium is fully understood by me.

Signature Date

Contact email Contact phone number

1. Are you a U.S. citizen or permanent resident? Yes No
   If your answer is “NO” please continue to question 2 and 3:

2. In the previous 6 months, have you received honoraria payments and associated expenses from more than five institutions? Yes No

3. The honoraria payment and/or associated expenses I will receive from are for usual activities and that those activities do not/will not last for more than . Yes No

Patient Centered Rules of Engagement

A powerpoint was developed to support the needs of multi-stakeholder teams who engage in collaboration for healthcare transformation and research. This tool may support the needs of all members of your team as you work together on system improvements. It can be viewed as a powerpoint or it can be printed and laminated as a fun and accessible mini guide.