Questionnaire for ADFM Healthcare Delivery Transformation Consultation Service
Our 2019 ADFM Annual Survey asked about your interest in potential consultations or discussions with colleagues on issues around transforming healthcare delivery. Over 73% of you indicated interest. After a successful pilot in the summer of 2020 that involved 12 consultations, we are setting up a resource list of members with varying areas of experience and expertise that will be available for a potential consultation or coaching session. We know how valuable everyone’s time is, and therefore would ask you to complete the following form to gather some helpful information so that we may assign you to the appropriate consultant.

*LEVELS OF DEPTH OPTIONS AND COSTS
A) Quick 30-min phone call/exploratory consult = no charge
B) More extensive/longitudinal phone consults = $250/hour (including prep time)
C) In person onsite consult = $5,000 plus travel, lodging, meals (due to COVID, this option is not being offered at this time, but we hope to in the future)
Email address *
Instructions:
Instructions: Take a moment to answer the following questions. Within 72 business hours, you will receive a follow-up email with next steps. Please note that during this pilot we are accepting up to 15 requests and selection is based upon a first come first serve basis. Additionally, the response time depends on your request and our consultants' availability. Please email any questions to Samantha Elwood (selwood@adfm.org).
My question(s) center on the following:
Clear selection
What are the questions you would like to be answered/problems you would like to be solved in this consultation?
What additional background information can you share so we have some context to your questions/problems?
Size of my practice/group:
Number of empaneled patients:
Current way we are meeting MACRA:
Additional types of contracts or populations that involve risk or value components:
Which EMR do you use?
My role in driving transformation for the department/system is:
Beyond receiving a consultation, are you also interested in become a consultant yourself?
Clear selection
Next
Never submit passwords through Google Forms.
This form was created inside of Society of Teachers of Family Medicine. Report Abuse