Introduction to Collaborating

Introduction

This guide will help you make the most of your collaboration. Whether you're new to this partnership or experienced, we've got you covered.

Our goal is to help you succeed in your collaboration. We hope this helps you not only understand the basics of a successful collaboration but also have practical insights on how to excel in your collaborative efforts.

Post-Signature Activities and Timeline

Once you have signed your collaborative practice agreement, please be sure to review and complete each step below as your agreement is now active. Here are your final requirements to start your collaboration! 

STEP	RESPONSIBLE PERSON	TIMELINE
Login to Zivian Profile and review executed agreement	Physician and Practitioner	Immediately
Submit additional documents to the state Medical Boards	Practitioner Initiated	Immediately
Set up your payment method in the Zivian platform	Practitioner Initiated	Immediately
Schedule initial meeting	Practitioner or Physician Initiated	Within 5 days
Get added to new or existing Monthly Meetings facilitated by the Physician	Physician Initiated	Within first 7 days
Continually meet monthly commitments required in the agreement	Physician and Practitioner	Ongoing

Initial & Ongoing Monthly Meetings

In this section, we focus on your initial meeting as well as the monthly meeting requirements,  designed to enhance our collaboration. The meetings provide a structured framework for open discussions, in-depth clinical case reviews, educational exchanges, and professional development. This section provides guidance, examples and best practices on the process for the initial and ongoing meetings as well as potential discussion topics. 

Initial Meeting as Collaborators

The initial meeting after a collaboration agreement is signed must happen in the first 7 days. This can be a telephone call, a video conference or in person. During this meeting you will want to discuss the following:

• Schedule or be added to existing monthly meeting
• Establish communication schedule and preferences
• Login to Zivian and review Attestations

Monthly Meetings

Each collaboration is required to meet at least monthly and attest to the meeting. These meetings may be independent one on one or held in a group setting, which is recommended. The intention of these meetings is for collaborating physicians to provide additional support, guidance, and education to practitioners. The below outlines a proposed agenda and potential topics of discussion:

Proposed Agenda

• Check-in and Welcome: Begin with a quick welcome and check-in to set a positive tone for the meeting.
• Review of Patient Cases: Focus on patient care issues, clinical questions, etc.  Discussing any urgent or high-priority patient cases that require immediate attention or coordination should not be held until the monthly meeting; rather these cases should be communicated in real time with the Physician.
• Operational Questions:  This can be questions around logistics such as med-mal providers, recommendations on EHRs, or thoughts around particular workflows or best practices. 
• Quick Updates: Share brief updates on recent medical developments, important guidelines, or essential information that everyone should be aware of.
• Case Studies and Complex Cases: Analyze complex patient cases in detail, exploring diagnostic challenges, treatment options, and the rationale behind decisions made. This can enhance clinical reasoning skills

Additional Meeting Topics and Discussion Items

If you would like to discuss other things in your monthly meetings, here are some proposed topics to continuing fostering a good and supportive collaboration: 

Topic	Options and Examples
Interdisciplinary Collaboration	Discuss strategies for collaborating effectively with other healthcare professionals, such as nurses, pharmacists, social workers, and specialists, to provide holistic patient care.
Evidence-Based Medicine (EBM)	Deepen the understanding of EBM principles and critically appraise the latest research studies and their relevance to clinical practice.
Ethical and Legal Considerations	Address ethical dilemmas, legal issues, and informed consent, especially in cases where decisions might be challenging.
Quality Improvement Projects	Plan and execute quality improvement projects aimed at enhancing patient outcomes, reducing errors, and optimizing workflow processes.
Patient Education and Counseling Techniques	Share techniques for effective patient education and counseling, especially for chronic disease management and lifestyle modifications.
Cultural Competency and Diversity Training	Explore strategies for providing culturally competent care and ensuring sensitivity to the diverse backgrounds and beliefs of patients.
Mental Health and Well-being	Discuss strategies for managing stress, compassion fatigue, and burnout in healthcare professionals. Promote mental health and well-being among team members.
Medical Technology and Innovations	Stay updated on the latest medical technologies, telemedicine trends, and innovations that can improve patient care and practice efficiency.
Continuing Education Plans	Develop continuing education plans based on their professional goals and areas of interest.
Patient Safety	Review patient safety protocols, adverse event reporting, and strategies for preventing medical errors.
Healthcare Policy and Advocacy	Discuss healthcare policy changes, advocacy efforts, and how healthcare providers can engage in shaping healthcare policy at local, state, or national levels.
Research and Publication Opportunities	Encourage team members to engage in research projects and explore opportunities for publication, if applicable.
Long-Term Planning	Develop long-term goals and strategic plans for the healthcare team, including expansion, specialization, or adopting new services.

Zivian Documentation & Compliance Requirements

You are required to login to your Zivian profile and submit your attestations each month. When logging in, you must review and confirm all requirements for each state you are collaborating in. Failure to complete these monthly requirements can put your compliance status at risk. 

How to Access Your Collaborations in the Platform

Once your collaborative practice agreement has been signed, it will be added to the Zivian platform. You will be able to search for any collaborations that you have through Zivian by clicking the “Collaborations” button in the top left corner of the page.

The Collaborations view can be filtered by state, monthly attestation status, or collaboration status. If any of your collaborations have monthly requirements that still need to be completed, they will have an “Action Required” status next to them in the list. 

To view details about each collaboration, click your collaborator’s name and review additional information about them. Here you will find your collaborator’s contact information and your collaboration documents. 

If you see any “action required” flags, that means that there is still an outstanding monthly requirement that has not been completed.

Once you have completed your monthly attestations, the “action required” flag will change to “completed”. You will also be able to download your attestation report and keep it with your other collaboration records in the “Documents” sections within your profile and under each individual collaboration.

All of your documents related to your collaboration and your relationship with Zivian can be found in the Documents section under the Profile tab on the left.

Chart Reviews 

Depending on the state and the nature of the collaboration, different regulatory requirements may mandate a certain amount of chart reviews. These reviews play a pivotal role in ensuring patient safety, compliance with regulations, and the overall quality of healthcare services.

When reviewing health records, there are specific elements that must be assessed, as well as specific areas of focus as requested by enterprise clients. We have outlined below the key components that collaborating physicians may focus on during chart reviews:

Medical History	Review the medical history, including previous illnesses, surgeries, and chronic conditions. Assess the accuracy of family and social histories, as they may impact treatment decisions.
Chief Complaint and Presenting Symptoms	Evaluate the chief complaint and present symptoms to understand the reason for the current healthcare encounter. Ensure that the documentation captures the patient's concerns and symptoms comprehensively.
Assessment and Diagnosis	Evaluate the assessment and diagnosis based on the available information. Verify that the diagnosis aligns with the patient's symptoms and/or documentation.
Documentation of Medical Necessity	Review the patient's medical history and the documented medical necessity for the prescription of controlled substances. Verify that the patient's condition meets the criteria for such treatment.
Quantity and Dosage	Ensure that the prescribed quantity and dosage of controlled substances are appropriate based on the patient's condition, medical history, and treatment guidelines.
Treatment and Follow-up Plans	Review the treatment plan, including medications, procedures, and referrals. Ensure that treatment options are evidence-based and aligned with best practices.
Progress Notes	Scrutinize progress notes for each encounter to assess the continuity of care and ensure that notes are comprehensive and provide a clear picture of the medical history.
Care Coordination and Referrals	Confirm that referrals to specialists or other healthcare providers are made when necessary. Ensure that care coordination efforts are well-documented.
Prescription Monitoring Programs (PDMPs)	In states with Prescription Drug Monitoring Programs, confirm that the healthcare professional is using these databases to check a patient's prescription history for controlled substances to prevent overuse or misuse.
Compliance with Regulations	Verify compliance with state and federal regulations governing telemedicine, EHR usage, and patient privacy (e.g., HIPAA)