As a medical assistant, Erica Deming walked a patient to the exam room, took vitals and left the room so the physician could carry out the rest of the primary care visit behind a closed door.
Then, working as a care team coordinator (CTC), Deming—now a medical student—was in the exam room helping patients and family physician Jeff Panzer, MD, the vice president of care transformation at Heartland Health Centers in Chicago. Dr. Panzer’s office has two care team coordinators for every one physician. A care team coordinator will first room a patient. Then when the physician is in with that patient, the other coordinator is rooming the next patient that the doctor will see.
Deming documents the conversation between the patient and Dr. Panzer. She also enters laboratory tests that need to be ordered, along with medications that Dr. Panzer will need to sign. If needed, she coordinates with specialists to do a warm handoff or pulls records from a hospital or other caregiver so that Dr. Panzer can see them before he leaves the exam room.
Once the visit is complete, Deming is able to answer patient questions about next steps. It’s something that would have been impossible before because she wasn’t in the room to hear what the physician was telling the patient.
The work is far more rewarding for Deming, patients get better care and Dr. Panzer is able to spend more time focusing on the patient in front of him.
Dr. Panzer and Deming discussed how the practice’s advanced team-based care model works and the positive impacts the approach has had on patient care during an “AMA STEPS Forward® Podcast” episode.
You can listen to the podcast, “Improve Patient Care with Collaborative Care Team Models,” on Apple Podcasts or Spotify.
Establish relationships with patients
The change to a team-based care model is about primary care physicians “allowing other people into the relationships with patients and into the core part of medical visits, which is agenda setting, history taking, etcetera,” Dr. Panzer said, adding that care team coordinators are also building trust and relationships with patients.
“Through those relationships they are able to identify things in their history, for example, that I wouldn’t have been able to get,” he said. “Care coordinators will come back to me after I’ve left the room and tell me that the patient didn’t necessarily agree with the plan but didn’t feel comfortable speaking of it.
“There’s another set of eyes, ears and another relationship that’s formed between patients and care coordinators and that’s important,” Dr. Panzer said.
Physician is team leader
It’s very rare that a patient has asked to only have the physician in the room during their exam, especially once it is explained that the physician will be able to spend more time focused on the patient rather than having to multitask at the computer taking notes.
Dr. Panzer said how physicians present themselves is very important. He views himself as a team leader.
“I enjoy developing strong personal relationships with my patients, but I also try really hard to make sure my care team coordinators also develop a strong relationship with patients,” he said. “We work hard to make sure the same CTC is seeing the same patient with continuity in future visits.”
Additionally, “I try to make sure as I’m explaining something to my patient my CTC is understanding it because I know when I step out of the room, they are going to get the questions,” Dr. Panzer said, noting that “I view it as my job to teach my CTCs and to make sure I’m listening to them.”
Dr. Panzer’s heard it said that advanced team-based care is “like a dance and sometimes you step on each other’s feet, but it’s better than dancing alone,” he said. “Overall, it is really phenomenal when it works well and most of the time it does work well.”
The AMA STEPS Forward open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These toolkits can help you prevent physician burnout, create the organizational foundation for joy in medicine and improve practice efficiency. One CME toolkit specifically addresses team-based care.