2016

Changing Provider Roles: How Care Models are Moving from Single Providers to Team-Based Care

In today’s evolving health care system, medical care is no longer a one-man or one-woman show starring just a physician. Instead, care models have shifted to focus on team-based coordinated care, which has been shown to improve patient outcomes and lower overall costs of care. 

While effective, team-based coordinated care presents new complexities and challenges that care teams must navigate. Physicians play the crucial but difficult role of leading care teams and ensuring effective, coordinated care that improves patient outcomes and lowers costs.  

Team-Based Coordinated Care

Team-based coordinated care is widely becoming known as a best practice that delivers on the triple aim by improving care and health and lowering costs. The American Academy of Family Physicians (AAFP) includes “integrated and coordinated care” as a key aspect of the patient centered medical home (PCMH) model. This means patients receive coordinated care in a medical neighborhood led by a physician. The physician-led team may include nurses, physician assistants, pharmacists, specialists and case managers, among others. True team-based care means constant communication among multiple providers, as well as the patient and the patient’s family. 

The Challenges

Coordinating care among various providers in multiple locations poses numerous challenges. Constant communication via email and phone is crucial, so care plans must include time and support specifically for communication. One primary care physician illustrated the process he experienced providing team-based coordinated care for a 70-year-old cancer patient. The effort included 52 emails and phone calls, five procedures and 11 office visits that involved 12 clinicians, the patient and his wife, all occurring over 80 days from MRI to tumor resection. 

Research has also found conflict among provider teams is more likely to arise when teams provide care in different locations, than when team members work together in one location. Unifying teams in multiple locations requires strong leadership and constant communication.  

The Benefits

When implemented efficiently and effectively, team-based coordinated care has been shown to improve patient outcomes and lower health care costs. Coordinated care helps prevent unnecessary costs that inevitably arise when patients see multiple providers for multiple conditions without any coordination, from factors such as hospitalization, extra prescriptions and missed prevention opportunities. One study estimates a potential $240 billion in savings from improved care coordination efforts.

The team-based PCMH model in particular has been shown to improve outcomes and lower costs. The Patient-Centered Primary Care Collaborative’s most recent annual report detailing the cost and quality impact of the PCMH model found 23 of 25 PCMH studies reporting on utilization measures found reductions in one or more measures. Twenty-one out of 23 studies on the topic found PCMHs led to cost reductions in one or more measures. 

Physicians as Leaders

It takes a strong physician leader to lead a coordinated care team. When executed correctly, however, team-based coordinated care can seriously benefit individual patients and the overall health care system. To put the effort into perspective, read about one primary care physician’s experience “quarterbacking” a health care team here.