The PCMH Neighbor concept encourages the building of bridges between specialists, referring clinicians, hospitals, and other health care professionals. The ACP Practice Biopsy questions and explanations are from the 2019 NCQA Patient-Centered Specialty Program and were used with permission from NCQA.  There are seven categories of standards and guidelines.  This section of Practice Advisor covers six of the seven categories:  Referral Management, Know and Manage Your Patients, Patient-Centered Access and Continuity, Plan and Manage Care, Care Coordination and Transitions, and Performance Measurement and Quality Improvement. The competencies for Team-Based Care and Practice Organization are addressed across several Building the Foundation modules, such as Communicate with Patients, Working as a Team, and Organize Your Practice.

Drs. Carol Greenlee and John Cox were major contributors to this section of ACP Practice Advisor®.