Implement multi-component efforts that include coordination of health services by multidisciplinary teams of health care professionals, patient self-management, and patient education
Support a collaborative approach by a multidisciplinary team of professionals working to meet the full range of long-term care (LTC) needs for frail elderly patients living in community settings
Provide culturally sensitive assistance and care coordination, and guide patients through available medical, insurance, and social support; also called systems navigators
Provide interpretation services for patients with limited English proficiency (LEP) in outpatient and inpatient health care settings, following training and certification