The Executive Suite: How to deliver team-based care

Need more hours in a day? You’re not alone.

A physician with a panel of 2,500 patients could spend nearly 22 hours per day providing the recommended acute, chronic, and preventive care as well as conducting effective care management and outreach, according to research findings in American Journal of Public Health and Preventing Chronic Disease.

And that’s not taking into account the national shortage of primary care physicians (PCPs), the rise in non-direct patient care, and clerical workload or the more than half of physicians who reported feelings of burnout in 2017, up from 40 percent in 2013.

“With these new demands, the ability for physicians to see patients has decreased,” says Joseph Behn, MD, family medicine provider at Mayo Clinic Health System in Onalaska, Wis. “The amount of time physicians actually spend doing what they are trained to do—such as interacting with patients, examining them, and formulating diagnoses and treatment plans—has markedly declined. By delegating tasks, PCPs can alleviate this aspect of the work burden and allow physicians to reacquire the ability to practice again.”

Physician assistants (PAs), nurse practitioners (NPs), pharmacists, and other support providers are valuable members of care teams at primary care physician (PCP) practices. These non-physician providers can make practices more efficient and effective, allowing all team members to work at the top of their licensure.

Building a care team

“Treating patients as a team helps to meet their diverse needs, including physical, mental, social, and spiritual,” says Cheristi Cognetta-Rieke, DNP, a nurse administrator at Mayo Clinic Health System in La Crosse, Wis. “A team-based approach allows a care team to collectively manage larger, more complex panels of patients and achieve wellness and health more effectively than any provider can do as an individual.”

By having several healthcare professionals coordinate a patient’s care, teams are more likely to identify all potential issues—which might otherwise fall outside of their individual scope of care—and improve outcomes.

A collaborative team of clinicians affords patients access to a team member they know faster than their PCP or when their PCP is not available, such as after patients are discharged from a hospital or care facility. “This allows for a timely response from a team member who is familiar with a patient’s condition,” says Arnold DoRosario, MD, primary care physician and chief population health officer at Northeast Medical Group/Yale New Haven Health in New Haven, Conn. “In turn, patients are comforted by personalized care.”

Added skill sets

Molling’s practice has both NPs and PAs who alleviate the clinical burden by seeing both walk-in and scheduled patients. They help with patient management by relaying patient results and plans of care, coordinating care if results necessitate additional communication with other providers, and having discussions with consulting physicians, insurance companies, and ancillary staff as needed. They can also see complicated patients or those who take more time along with a PCP.

PAs can also bring different skill sets to a practice, such as expertise in nutrition or the ability to perform a less common procedure, says L. Gail Curtis, MPAS, PA-C, DFAAPA, president and chair of American Academy of Physician Assistants’ board of directors. She previously practiced in otolaryngology, where she learned how to do a nasopharyngoscopy, a procedure that uses a fiber optic tube to look at the larynx. That’s a procedure not all PCPs do and an example of how PAs can add to a practice. Those skills also benefit patients, who could avoid having to make a second appointment and the potential wait to see a specialist.

Clinical pharmacists, another type of support provider, can see hypertensive patients and patients on anticoagulation therapy or on chronic opioid therapy, especially if they are tapering off such a drug, says Richard Furlong, MD, section head at Virginia Mason Kirkland Medical Center in Kirkland, Wash. They can also provide direct and indirect follow-up care for patients who are on antidepressant therapy.

Oftentimes, a pharmacist has the most in-depth knowledge of drug interactions, over-the-counter medications, and timing of administration and can collaborate with a PCP to provide medication-related support directly to a discharged patient, says Ken Goldblum, MD, chief medical officer of Tandigm Health in West Conshohocken, Pa.

Getting started

Before employing a care team, PCPs should analyze their patient population, conduct budget and staff forecasting to make sure they are allocating resources appropriately and develop workflows to ensure clear delineation of responsibilities. This daily clinical workflow should build on team members’ strengths to maximize efficiency. As an added bonus, spreading clinical and administrative responsibilities across a care team might also reduce the risk of PCP burnout, says Erin Mastagni, senior manager at ECG Management Consultants, a healthcare consultancy that helps providers through transformational initiatives in New Orleans.

Clinical team member huddles to identify optimal task allocation for the day and/or week can be quick but high-value moments. If feasible, co-location such as shared office space or working in the same hallway can help improve communication, too.

For some physicians, it can be difficult to delegate duties to others and relinquish control. “PCPs need to change their mindset: By having the right person doing the right task at the right time, they can optimize and improve their ability to care for their patients,” Behn says.