At Bellin Health in Green Bay, Wisconsin, 92 percent of physicians and staff are satisfied with their jobs. That remarkable achievement can be attributed to the system’s team-based care model. Since implementation in 2014, AMA member James Jerzak, MD, has seen a significant reduction in burnout across all staff, as well as improvement in patient satisfaction and quality of care.
“Our focus really shifted from trying to deal with burnout to trying to take better care of the patients,” said Dr. Jerzak, a family physician, during the Team-Based Care Training Camp, held by the AMA and Bellin Health in meeting spaces housed in Green Bay’s famed Lambeau Field.
“Team-based care is just a means to the end of taking better care of the patients,” Dr. Jerzak said. “Solving burnout was just the result of better processes and workflows.”
Team-based care helped to “bring the joy back into practice,” said Kathy Kerscher, team leader of achieving population health through team-based care at Bellin Health. There are 95 primary care teams using team-based care in the health system. The next step will be to look at the pediatric population to see how it mirrors the team-based model in primary care practices.
“Not everything is a cookie cutter. We have to have the unique situations or be aware of those things because not everybody is the same,” said Kerscher. “What an RN does in a family clinic is different than in a pediatric clinic.”
From “I” to “we”
One major change at Bellin Health is take the weight off physicians’ shoulders by allowing other team members to do more.
“The world that clinicians are in right now—if you’re not in team-based care—is everything files right through you,” said Dr. Jerzak. “It is very inefficient and frustrating for the providers.”
Team-based care changed the “I” to a “we,” said Kerscher.
For example, after meeting with the patient, Dr. Jerzak goes to his computer to sign off on any pending orders that the care team coordinator (CTC) entered. But beyond that, he usually closes the chart immediately while the CTC finishes up with documentation for the patient.
The goal is to close 90 percent of charts by 6 p.m., said Dr. Jerzak, “because we don’t want that pajama time,” he said. “We really try to get work done by the end of the day so people can leave.”
In-basket management in the new Bellin Health approach has improved dramatically.
“In the old world, every time I clicked refresh after meeting with a patient 20–30 things pile into the in-basket and it was unsustainable. It really drove me crazy,” said Dr. Jerzak. “If I had to go back to the old way, I would immediately retire.”
The transition period for Bellin Health offices gearing up with the team-based care approach is about six months. But the results show that the move is worth it.
On experience of care, Bellin Health saw a 2.2 percent increase in top box likelihood of recommending the practice or physician. For the health of the population, there was an average of 8.8 percent improvement in seven key metrics. And revenue improved, with Bellin bringing in $724 more in payments per patient annually.
And patients see and feel the difference that team-based care can make, Dr. Jerzak said. It was in the first week his office had transitioned to the new approach that a patient offered up a memorable assessment.
“I feel,” the patient said, “like I got my doctor back.”
The AMA’s STEPS Forward™ collection offers free online modules that help physicians and system leaders improve well-being, including learning about the organizational changes that lead to physician satisfaction and improving practice efficiency. All of the modules have free CME and are accredited for MOC Part II.
Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.