North Sound ACH 7/18/2018 - Laserfiche WebLink

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 E No If yes,identify key personnel for these activities Is your organization willing to measure and assess progress and continuously improve processes? ❑✓Yes 1:3 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 transformation efforts? ✓❑Yes ElNo Does your organization Include patients and/or clients in: EDGovernance(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)? El Yes, we have the capacity currently`to transform because: We continue to look for ways to tranform our repsonse to those in our community who 71 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 with the North Sound ACH. B /� Name(Printed): f I�-44 f!/1 q . ._.... . Title;. .()U./ ( L eG( a hL9' S-4 t)e O i v c(" r". Signature: ik''Z 1_2 t_ ".`.� �— Date: CO ( a.k North Sound ACH May 2018 Call for Partners Application 4