Payment & Delivery Models

Private practice: 4 ways team-based care can boost the bottom line

A Wisconsin health system raised its quality scores, generated more revenue, lowered costs, and boosted clinician satisfaction after just 12 months of operating under a team-based care model.

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Burnout-producing administrative burdens and the need to prepare for value-based payments made it critical for Bellin Health to move away from traditional practice patterns and creatively rethink how it delivered health care.

The solution developed by the 160-provider multispecialty system is the advanced Team-based Care (aTBC) model, which includes a physician and other members of the practice staff “up trained” to take on new roles and responsibilities that allowed doctors to devote more time to see patients.

There was some concern that “some physicians might perceive team-based care as eroding their responsibility for patients’ care,” according to the article “Advanced team-based care: How we made it work,” published in the Journal of Family Practice.

“This can be a cultural shift for physicians, yet it is critical that they take a leadership role in this transformation,” says the article, co-written by James Jerzak, MD, a Bellin Health family physician; Gina Siddiqui, MD, an emergency medicine resident at Yale New Haven Hospital; and internist Christine A. Sinsky, MD, the AMA’s vice president for professional satisfaction.

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The care team roster included certified medical assistants (CMAs) and licensed practical nurses (LPNs) and training them to take on new roles as care team coordinators whose duties included direct clinical support for physicians and “intensive” electronic health record support so that doctors could focus on the patient and not documentation.

Another change involved registered nurses (RNs) who previously were mostly doing telephone triage. Under the aTBC model, care team RNs began providing diabetes education, BP checks, and annual Medicare wellness visits. The extended care team of social workers, clinical pharmacists, diabetes educators and RN care coordinators provided resources to help meet the needs of more complicated patients.

The authors noted that the aTBC model was also “successful from a financial point of view,” and they attributed this sustainability to these four factors.

Team based care led to more productivity from physicians and nurses. Doctors were able to see one to two more patients per half day. Nurses typically are generating 3.5 billable visits a day, and this is expected to grow to four billable visits.

The ability to focus on patients’ full range of needs led to more thorough service. This led to appropriately higher levels of billing codes. Billing revenue per patient grew by $724 per year, in part due to providing more preventive services such as immunization, mammography and colonoscopy.

The aTBC model created opportunities for new billable services. This includes RN BP checks and annual wellness checks. Revenue from RN visits was $630,000 in 2018.

Patients had increased access. Of the 130 primary care providers practicing in the aTBC model, 15 (11.5%) had previously closed their practices to new patients. After implementing aTBC, they all welcomed newcomers. A 2018 patient-access survey found that 96.6% of patients felt they were able to schedule an appointment when they needed one, compared to 70.7% before the transition. Patient panels for primary care physicians and other providers grew by an average of 8%.

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Another indicator of economic stability included lowering per-patient per-month spending by $29 for patients in Bellin Health’s Next Gen accountable care organization, which was attributed to expanding the roles of nonphysicians and lowering hospital admissions by 5%.

A spring 2018 survey found that, among physicians who transitioned to an aTBC practice, 83% were moderately or very satisfied with their work experience, compared with 70% practicing in the traditional model.

The AMA STEPS Forward™ collection of open-access modules has two related to Bellin Health’s experience, including one on medical assistant professional development and another on implementing team-based care.

STEPS Forward is part of the AMA Ed Hub, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards. 

Learn more from the AMA about why the potential for greater pay and higher autonomy make private practice an attractive option for physicians looking to have more control over practicing medicine.