While health systems across the country are implementing team-based care, few are doing it in exactly the same way. But many are doing it for the same reasons.
“There’s never any straightforward or easy patient anymore,” said James Jerzak, MD, of Bellin Health, in Green Bay, Wisc. “In Wisconsin, the copays and the deductibles are huge. So every office visit is jammed with a lot of questions, and it can be really overwhelming to the individual clinician.”
Dr. Jerzak, a family medicine physician, made his remarks in a recent presentation, “Restoring Joy in Practice through Team-Based Care,” at the University of Illinois at Chicago (UIC). UIC is a part of the Great Lakes Practice Transformation Network, a regional group that encompasses Illinois, Indiana and Michigan. Practice transformation networks are peer-based learning networks designed to coach, mentor and assist physician practices and health care systems.
Team-based care, he explained, is a means to an end: effective population health management. But it can deliver another, equally positive effect.
“This is what solves the burnout problem in this country,” he said. “It’s not some of these other things that put band-aids on it. You have to take away the causes of burnout—the EHR demands and the demands of the complicated visits.”
Bellin Health is a relatively small health system, with 35 clinics, one hospital and about 150 physicians and other health care professionals. It is primarily fee-for-service, and its leadership knows the impending shift to value-based payment will require changes in how care is delivered.
The best way to improve quality measures, Dr. Jerzak has found, is to get the physician out of the picture and let the team handle a lot of tasks.
To do this, Bellin Health is implementing a team-based care model that, for starters, greatly expands the roles of medical assistants and licensed practical nurses to serve as care team coordinators (CTCs). Following standard rooming procedures, the CTC:
- Populates visit diagnoses from problem list
- Sets up one-year refills
- Identifies the visit agenda
- Identifies and addresses care gaps
- Pulls up appropriate template
- Starts documentation
Here’s how it works.
The physician enters the room without a computer and, after a warm handoff, addresses the patient. The CTC remains in the room, continuing documentation in the background so the physician can focus on the patient and MD-level work.
The CTC then reviews tests, provides some health coaching and motivation to the patient and makes sure the patient understands the care plan. The CTC also enters orders for consults, new medications and tests and acts as patient advocate.
Meanwhile, the physician returns to a computer station in a colocation space to edit documentation and review and sign off on orders. The patient’s chart is usually closed before the physician goes on to the next exam room.
“The thing I find most satisfying in this is empowering the staff,” Dr. Jerzak said. “I love it when I’m in the room and I’ll say to the care team coordinator, ‘Let’s have case management involved,’ and they look at me and say, ‘I already ordered it.’ We don’t need the clinician to be approving everything when it’s obvious it has to be done.”
Other lessons Dr. Jerzak said Bellin Health learned from adoption of team-based care:
- Colocation is critical and can be done without any extra staff
- Electronic messaging is very inefficient and should be avoided
- The number one thing in team-based care is personality—being able to work with the people around you
Dr. Jerzak noted that burnout is not limited to physicians—in fact, it affects all health care professionals—and he thinks team-based care has the potential to restore joy not just to physicians but to everyone involved.
“When we’re in our pod and people are working, I often times stop and think that it’s just fun to do this again,” he said. “I think patients really pick up on that too.”
The AMA offers a free team-based care training module in its STEPS Forward™ collection of practice improvement strategies to help physicians make transformative changes to their practices. Other modules include starting Lean health care, implementing daily huddles and addressing EHR woes with team documentation.
Thirty-five modules are available, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.
Bellin Health will be hosting a team-based care Training Camp Nov. 1-3 at Lambeau Field, in Green Bay, and the International Conference on Physician Health, a collaboration of the AMA, the Canadian Medical Association and the British Medical Association, will showcase research and perspectives about Increasing Joy in Medicine for physicians Sept. 18-20 in Boston.