2018/07/11 Council Agenda Packet

Does your organization currently have an internal practice transformation, quality improvement,or population health management team that supports transformation activities through data and coaching? ❑Yes ✓D No If yes,identify key personnel for these activities -Is your organization willing to measure and assess progress and continuously improve processes? ❑✓Yes ❑No Is your organization able to participate in an online reporting system that may require the upload or submission of data and information related to.transformatipn_efforts? ..__ _.. . . Des ONo Does your organization Include patients and/or clients in: ri Governance(please describe) Operations(please describe) Decision making(please describe) Does your organization have the current capacity to implement significant change(s)(e.g.,will it compete with other major changes currently being instituted in your organization)? I I Yes,we have the'capacity currently td.trahgform because: . We continue to look for ways to tranform our repsonse to those in our community who 571 1 No,we do not have the capacity currently to transform because: Addressing the target population is only a small part of our police, fire/EMS, Muncipal Organization's Authorized Signer: I attest that I,the undersigned,have the authority to sign on behalf of my organization,and that the responses provided above are accurate and understand that by submitting the completed Application I am agreeing to the criteria laid out for participation in the 2018 Implementation Planning phase of the Medicaid Transformation Project Ka the North Sound ACH. Name(Printed): !4( 1 .. .... Title:..P4.7i I (,_:erect till S-4 re Ireeve- Signature: e -Signature: c- d..../ Date: (41 j t `� North Sound ACH May 2018 Call for Partners Application 4 131 •