The Virginia CHC Leadership Institute Survey

Question Title

* 1. Please list your contact information so we can enroll you in the online support center for the Virginia CHC Leadership Institute

Name

Organization

Position

	Low Interest 1	2	3	4	High Interest 5
a. Support for Implementing the Virginia CHC Value Model	a. Support for Implementing the Virginia CHC Value Model Low Interest 1	a. Support for Implementing the Virginia CHC Value Model 2	a. Support for Implementing the Virginia CHC Value Model 3	a. Support for Implementing the Virginia CHC Value Model 4	a. Support for Implementing the Virginia CHC Value Model High Interest 5
Priority topics:
b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics)	b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) Low Interest 1	b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) 2	b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) 3	b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) 4	b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) High Interest 5
Priority topics:
c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics)	c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) Low Interest 1	c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) 2	c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) 3	c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) 4	c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) High Interest 5
Priority topics:
d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics)	d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) Low Interest 1	d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) 2	d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) 3	d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) 4	d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) High Interest 5
Priority topics:
e. Community health indicators for your service region	e. Community health indicators for your service region Low Interest 1	e. Community health indicators for your service region 2	e. Community health indicators for your service region 3	e. Community health indicators for your service region 4	e. Community health indicators for your service region High Interest 5
Priority topics:
f. Economic impact analysis for your organization	f. Economic impact analysis for your organization Low Interest 1	f. Economic impact analysis for your organization 2	f. Economic impact analysis for your organization 3	f. Economic impact analysis for your organization 4	f. Economic impact analysis for your organization High Interest 5
Priority topics:
g. Additional areas of interest for best practice support	g. Additional areas of interest for best practice support Low Interest 1	g. Additional areas of interest for best practice support 2	g. Additional areas of interest for best practice support 3	g. Additional areas of interest for best practice support 4	g. Additional areas of interest for best practice support High Interest 5
Priority topics:

Low Interest 1

High Interest 5

a. Support for Implementing the Virginia CHC Value Model

a. Support for Implementing the Virginia CHC Value Model Low Interest 1

a. Support for Implementing the Virginia CHC Value Model 2

a. Support for Implementing the Virginia CHC Value Model 3

a. Support for Implementing the Virginia CHC Value Model 4

a. Support for Implementing the Virginia CHC Value Model High Interest 5

Priority topics:

b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics)

b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) Low Interest 1

b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) 2

b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) 3

b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) 4

b. Best practice support for clinical management (quality strategy, analytics, care models, population health management, and other topics) High Interest 5

Priority topics:

c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics)

c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) Low Interest 1

c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) 2

c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) 3

c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) 4

c. Best practice support for organizational management (financial management, personnel, governance, Operational Site Visits, and other topics) High Interest 5

Priority topics:

d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics)

d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) Low Interest 1

d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) 2

d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) 3

d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) 4

d. Best practice support for community collaboration (community relations, creating partnerships, developing initiatives, and other topics) High Interest 5

Priority topics:

e. Community health indicators for your service region

e. Community health indicators for your service region Low Interest 1

e. Community health indicators for your service region 2

e. Community health indicators for your service region 3

e. Community health indicators for your service region 4

e. Community health indicators for your service region High Interest 5

Priority topics:

f. Economic impact analysis for your organization

f. Economic impact analysis for your organization Low Interest 1

f. Economic impact analysis for your organization 2

f. Economic impact analysis for your organization 3

f. Economic impact analysis for your organization 4

f. Economic impact analysis for your organization High Interest 5

Priority topics:

g. Additional areas of interest for best practice support

g. Additional areas of interest for best practice support Low Interest 1

g. Additional areas of interest for best practice support 2

g. Additional areas of interest for best practice support 3

g. Additional areas of interest for best practice support 4

g. Additional areas of interest for best practice support High Interest 5

Priority topics:

Question Title

* 3. Please use this form to list any additional individuals from your organization you would like to enroll in the online support center for the Virginia CHC Leadership Institute. Please list each individual's name, position and email address.

Individual 1 (Name, Position, Email)

Individual 2

Individual 3

Individual 4

Individual 5

Individual 6

Individual 7

Individual 8

Individual 9

Individual 10