The team-based care model: what is it and how can you use it in your own business?

During one of those sit around the table and talk with family after a big Thanksgiving meal moments, my mother, a soon to be retired registered nurse (RN) and I got into a discussion about team-based care. I was explaining to her that as part of my practice I was taking blood pressure measurements, adjusting medications and ordering lab work for a panel of patients with uncontrolled hypertension. My first instinct was to try and sell her on the idea that pharmacists can be really good at managing chronic conditions and not just “counting pills.”

Clearing up the misconceptions about pharmacists

As the conversation continued and we shared stories about the patients who had made an imprint in our brains, my mother had an about-face and as if out of nowhere asked, “Did you say that you are taking blood pressure?” I confirmed that, yes, I was perfectly capable of taking an accurate blood pressure measurement the old-fashioned way using a manual cuff and stethoscope. She was surprised to know this was in the realm of what a pharmacist can do. This coming from a woman who had close to 30 years of experience working in the healthcare system. She had seen pharmacists give advice on what medications to use or not to use but never heard of a pharmacist managing a disease state, let alone taking a blood pressure.

We spent the next 20 minutes discussing the concept of team-based care and how allowing individuals to perform work that is matched to their abilities has been shown to improve patient outcomes. I explained the concept of how when we employ the expertise of a variety of team members, patients are more likely to get the care they need. I was certainly not immune to the idea that this was not the model in every practice setting. Heck, it took me just under a year to convince the primary care provider who eventually started referring uncontrolled hypertensive patients to me. Once she started to see clinic BP readings drop and the number of patients with controlled blood pressure go up, she was sold on the model.

I thought I would take a minute to show you a picture of my team and I, since we're on the topic of team-based care models. I'm lucky to have developed such a skilled and driven team.

There are varying models of team-based care

Having practiced in a wide variety of practice settings across the United States, it is clear to me team-based care comes in all shapes and sizes. From a population health perspective, teams should be comprised of the resources patients in those communities require. It may be a social worker whose only job is to help patients get on the waiting list for subsidized housing in Philadelphia, a pharmacist in a rural Midwest town downloading blood glucose meters and titrating insulin, or a nurse practitioner whose expertise is implementing a methamphetamine and opioid treatment program.

How to develop your own model, no matter your profession:

One of the most common challenges I hear from health system administrators about shoring up a team-based care model is how to pay for it. The fee for service model does not allow to bill for the work done by a social worker. The newer pay-for-performance reimbursement models offer more flexibility for health systems to use the money how they see fit. In a future post I will cover reimbursement models in more depth. The process for executing an impactful team-based care model in all practice settings is similar. 1. Prioritize your population health initiatives 2. Identify ONE initiative to focus on (what is most costly to the practice, what you have the resources to address, what upper-level management is willing to consider, etc.), 3. Define measures of success and evaluation time points. 4. Start with a small pilot. 5. Evaluate and make changes based on the results.