As team-based models of delivering care become an increasingly common way to improve care coordination and efficiency, a new report offers guidance for the crucial elements physicians should consider when planning such a team.
The report (AMA login required) from the AMA Council on Medical Service stresses that there isn’t a single one-size-fits-all model for team-based care, and each physician practice should design its model according to its needs, the population it serves and state laws.
The report established policy defining physician-led team-based health care as “the consistent use by a physician of the leadership knowledge, skills and expertise necessary to identify, engage and elicit from each team member the unique set of training, experience and qualifications needed to help patients achieve their care goals, and to supervise the application of these skills.”
“The AMA believes that the ultimate responsibility for the individual patient’s medical care rests with the physician,” the report said. “Physicians must be responsible and have authority for initiating and implementing quality-control programs for non-physicians delivering medical care in integrated practices.”
The council outlined elements physicians should consider when planning a team-based care model for their practices, including:
- A patient-centered focus. A relationship is established between the patient and the team at the onset of care, including explanation of each team member’s role in care. Patients have access to the team or designated coverage at any time of day or night and are treated as integral members of the team providing their care.
- Teamwork. Physicians lead the medical team and have the ultimate responsibility and authority to carry out final decisions. The number and variety of practitioners in the team reflects the needs of the practice. Interdependence among team members is expected, and communication is routine. Team members complete tasks according to set protocols as directed by the physician leader.
- Clinical roles and responsibilities. Physician leaders are focused on individualized patient care and treatment plan development. Non-physician practitioners are focused on providing treatment within their scope of practice, and as delegated and supervised by the physician leader. Care coordination and case management are integral to the team’s practice.
- Practice management. Electronic health records are used to the fullest capacity. Quality improvement processes are in place and constantly evolving. The practice uses data analytics, including statistical and qualitative analysis on costs and use.
“Leadership on teams of highly-skilled health professionals doing complex or innovative work does not require physician leaders to have all the right answers for every task the team needs to accomplish,” the report said. “Rather, it requires physicians to ask the right questions, invite participation, communicate clearly, promote a culture of respect, reward excellence and ensure accountability, among other important leadership skills.”
Through its Professional Satisfaction and Practice Sustainability initiative, the AMA is identifying effective care delivery and payment models to improve the quality of patient care, reduce health care costs for the nation and increase professional satisfaction.
Physicians also can use educational webinars and practical guides from the AMA Innovators Committee to learn more about how to implement new care delivery and payment models into their own practices.
