Team-based care paying off in bottom line, staff development

Teamwork is hardly a new concept, but it’s beginning to be embraced more and more by physicians seeking to provide top-notch patient care and strike the perfect balance of personal and professional satisfaction.  

“It's taken a long time for many doctors to realize, especially with the complexity of population health measures and all the different things that happen in the electronic medical record, that they can't do things by themselves anymore,” said Michael O’Connell, MHA, FACMPE, FACHE, Senior Vice President of Operations with California’s Stanford Healthcare. “And so there's a much greater desire, for both professional fulfillment as well as for joy of practice, to work with the team.”

O’Connell recently spoke to MGMA Sr. Editor Daniel Williams on the MGMA Insights podcast about that transition to team-based care and the multiple benefits it can provide, not only for patients, but for the personal and financial well-being of frontline medical staff as well.  

The Triple Aim

“The Triple Aim is all about being more cost-effective, achieving quality outcomes – which includes the population health outcomes and then improving the patient experience,” he said. “And this approach has definitely helped us in all of those areas.”

O’Connell’s team includes 42 HIMS staff serving 320 providers in the Bay Area. With so much diversity in practice, O’Connell said both customization and standardization of team-based care initiatives are critical to the success of such programming. 

“There are opportunities for our providers to do a little bit of customization because there are certain providers that want to be more involved in efforts, while others are very comfortable in terms of partnering with their teams,” he said. “We've developed that centralized Health Information Management Department, where HIMS people used to be located at the local level. And it's helped us to achieve phenomenal productivity, efficiency, standardization and turnaround times.”

Huddle up

Stanford Healthcare has adopted six elements of team-based care, helping to efficiently and comprehensively guide patients through the entire health cycle. O’Connell said that begins with a pre-visit prep, a careful review of records, and the assurance that the provider and the medical assistant are huddling like a sports team and well aware of potential issues.

“Then, there’s patient rooming – how do we make sure that everything’s consistent, from the supplies to the different things that are expected to be communicated with the patient before they see the provider,” he said. Then, there’s the handoff – how does the medical assistant pass along the information from the patient to the physician, so they’re not necessarily (duplicating information)?”

Most importantly, O’Connell said his team works to create an electronic in-basket that helps to coordinate the multiple levels of electronic medical records, physician emails and the offline work management abstraction of all that data, so reports can be run and important details can be extracted. Have they had a mammogram or a colonoscopy, and when do they need to have one again? All of those details can be synthesized, which helps infinitely in coordinating care. 

When it all works, O’Connell said that the providers he’s worked with are vastly supportive of the notion of integrated team-based care. 

“We selected a region, we co-created with the providers, and it was all really slow and steady,” he said. “And word travels fast. You know you’re achieving success when the doctors are saying, ‘Well, when am I next?’ It’s all about having the administrator and the managers, plus our education team working together to be able to support the medical assistants, the HIMS people, as well as the providers. It was a real recipe for success.”

Show, don’t tell

Achieving buy-in on a coordinated care strategy also requires a nuanced and integrated approach, O’Connell added.

“This can’t be a top-down initiative that’s forced on the providers,” he said. This is something that they need to see has value. Initially, we had developed a model that was much more something they had to do, and there wasn’t buy-in and a consensus. So, we took a pause and said, ‘How can we work together and what do you need?’ Co-creation was an important part of this. 

“And there were still challenges, so we really had to get into the weeds and really support the providers to show them what’s being done. This is about trusting your staff and respecting them.”

Hear Michael O'Connell discuss team-based care starting at the 14:32 mark of this MGMA Insights podcast

ADDITIONAL RESOURCES:

• "A third of practices adopt team-based care in the past year" (MGMA Stat)
• "The critical role of advanced practice clinicians" (MGMA Insight Article)
• "Roadmaps to Value-Based Profitability: A Practice Transformation Guide" (MGMA Book)