MiPCT Regional Summit 2016 Care Management Session Social Determinants of Health, Agenda Setting, and Population Management Ann Arbor, October 26, 2016 Opening Statement Welcome and thank you for joining us for the MiPCT Care Management Afternoon Session. We’re excited about the expert facilitators that we have today for this interactive educational activity. The focus for this afternoon will be Brief Action Planning (BAP), Patient Engagement & Agenda Setting Before we get started, just a few points: • In order to make best use of the time that we have with our expert this afternoon, we will not have scheduled break times. Snacks will be provided in this room, and please break as you need to. • You will all stay in this room for the remainder of the afternoon, Does everyone have a packet of handouts? They include: Agenda/Evaluation link BAP Flow Case Study BAP Guide

Learning Objectives: Social Determinants of Health (SDH): Describe the impact of health disparities in patient care Describe the critical SDHs when supporting patients Agenda Setting: Describe techniques for agenda setting with the complex and/or disengaged patient Describe tools to facilitate decision making Population Management Discuss the importance of population segmentation for delivering self-management support Learn how to apply segmentation to a care manager’s caseload Today’s learning objectives are: (read slide)

Expert Presenters Kathy Reims, MD Cory Sevin, RN, MSN, NP From the Centre for Collaboration, Motivation and Innovation: Kathy Reims, MD Cory Sevin, RN, MSN, NP Kelly Reilly, RN, MS, CDE

Disclosure statement There is no commercial support for this activity. The following individuals have reported no relevant conflict of interest for the purpose of the MiPCT Summit 2016 Care Manager Session “Social Determinants of Health, Agenda Setting, and Population Management” Kathy Reims Cory Sevin Connie Davis Kelly Reilly Mike Hindmarsh Betty Rakowski Marie Beisel There is no commercial support for this activity.

CE Instructions for “MiPCT Summit 2016 Care Management Session” Nursing and Social Work 3.0 continuing education contact hours are available! To receive CE certificate - Attend the entire Afternoon Care Management Session Go to the MiPCT Demonstration web site https://mipct.org/ Once on MiPCT website – click banner titled “MiPCT 2016 Summit” Locate the Ann Arbor Summit information and click the link titled “Evaluation & CE Offering” Complete the evaluation steps, including your e-mail address An e-mail will be sent to your e-mail address with your CE certificate attached For technical assistance please e-mail: micmrc-requests@med.umich.edu

Recorded Summit Webinars (Pre-work) For those who have not yet done so, completion of the five recorded webinars prework is highly recommended. Each is available for nursing and social work CE contact hours until August 1, 2017. Our presenter for the recorded webinars is Connie Davis, RN, MN, GNP, co-director of the CCMI. The recorded webinars are posted on the www.mipct.org website on the Summit Prework Webinars page located under the MiPCT 2016 Summit tab. NEW for 2016: Stepped Care for Self-Management Support Available from 2015: Understanding Motivational Interviewing (MI): How the Elements of Motivational Interviewing Provide a Context for BAP Effective Communication with Patients (Ask-Tell-Ask): Identify ways to provide information consistent with the Spirit of MI Understanding Brief Action Planning: Describe the components of BAP Applying Brief Action Planning in the Care Setting: Identify the application of BAP in work settings

MiCMRC Team Members Lauren Yaroch, RN Jean Malouin, MD, MPH Medical Director Marie Beisel, MSN, RN CPHQ Senior Project Manager Judy Avie, BSN, M.Ed. IT, RN Population Health Consultant Scott Johnson, BBA, MSA, RN Project Manager Betty Rakowski, BSN, RN, MAEd Curriculum Designer Lauren Yaroch, RN Project Manager Sue Vos, BSN, RN MiPCT Master Trainer Cindy Stevens Administrative Assistant Sr. Julie Wolf

Questions Micmrc-requests@med.umich.edu Closing Statement We hope you found this afternoon’s educational session to be informative. We welcome your feedback on suggestions for improvement. • As a reminder, in order to receive your certificate for 3.0 Nursing Contact Hours, you must sign out as well as complete and submit the online evaluation, along with providing the email address where your certificate will be sent. What questions do you have? Thank you and safe travels home!