Team-based care is more than employing nurses, PAs and other practitioners in the field. It has to be a coordinated effort among all the health care players to provide a plan of care specific to a given patient.
Faced with an increasing emphasis being placed on team-based care, it would be tempting for physicians to assume that since they already employ nurses, physician assistants and other health-related practitioners within their medical practice, that they are already providing team-based care. That assumption, however, would be incorrect.
Jane Webster, senior vice president of research development and planning at URAC, defines team-based care as a coordinated effort among all the health care players to provide a plan of care specific to a given patient.
“It really means looking at the processes that need to be in place; looking at the areas of case management and disease management functions that are not totally integrated into the physician practice at this time,” she says.
Webster’s colleague, Christine Leyden, RN, MSN, vice president and general manager of client services and chief accreditation officer for URAC, echoes those thoughts.
“Team-based care is not just located within the walls of the practice,” she says. “The team includes all of the health professionals involved in coordinating care for the patient.”
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Frederick Southwick, MD, author of , (due out in April 2012) believes there are several key steps to implementing team-based care within a medical practice.
First, team members must “introduce themselves” and point out both their strengths and weaknesses. This helps to build trust immediately. Next, the team must agree on one or more measurable goals they will achieve, such as providing patient care that is efficient and error free. Third, they must discuss how they will communicate, and next they must agree upon the specific roles of each member of the team.
The team also needs to create milestones, as well as a set of norms or behavioral expectations: What will the team members always do and what should they never do? Then they must agree on how decisions will be made.
URAC’s Leyden agrees, and stresses the importance of having written documentation of the way the practice is going to consistently communicate with the patient, as well as members of the team.
“For example, what is their process of setting up their electronic health record?” she asks. “Is it going to talk to all of the members who are providing care for the patient beyond the practice, as well as the communication portal with the patient? Electronically, their phone standards, all of the ways that they’re going to communicate with the patient and the health care team, is it written down so that all the practitioners in the group are operating consistently? That’s essential to do.”
Webster calls the implementation of team-based care “a transformation,” and says the timeframe for putting all the components in place is approximately six months. Then, practices will begin to realize the benefits of the practice upgrade.
“It allows for elimination of gaps in care,” Webster says. “It provides more of a seamless way in which a patient moves through the system, and provides a way in which there is more support for the physician in being able to deliver the care. So it’s providing the team approach, where you have all of the components really working together.”
Cheryl Wu, MD, a pediatrician with LaGuardia Place Pediatrics in New York City, says her small practice consisting of two pediatricians and three other full-time staff members, has realized the benefits of a team-based approach to care.
They are able to do same-day office-to-office transfers to avoid the costly practice of sending patients to the emergency room.
“For example, I can send a simple laceration — so I act as the ‘triage system’ in the ER — to a plastic surgeon friend of ours who will see the patient the same day to suture it up,” Wu explains. “If we suspect appendicitis, we can draw bloods in my office, then send the child to a pediatric surgeon's office to be evaluated. The surgeon can then decide to take the child to CT scan, or to the OR, or admit for observation, thereby completely bypassing the ER.”
Support from payors
Both Webster and Leyden say they are seeing a significant movement, both at larger practices as well as smaller and specialty practices as well, to deploying a team-based approach to providing care.
“The movement of team-based care is being adopted by practices because this has transformed empowering the patient, but most importantly the payors are committed to promoting team-based care,” Leyden says. “So, getting the additional resources from a health plan, for example, such as a case manager to assist a practice and be a member on the team to help coordinate the care, is increasing the adoption of team-based care.”