Care Teams: Unlocking the "Value" in Value-Based Care

Outcomes are rapidly becoming the standard by which all providers are judged and the movement toward team-based care is gaining momentum. But what do care teams look like, and what roles do members play in a market where the new unit of exchange is value?

The only thing that’s constant is change. For today’s healthcare providers, that’s never been more true. But while there’s plenty of uncertainty around the Affordable Care Act and its potential replacement, it’s important to remember that legislation such as MACRA and the 21st Century Cures Act was passed with overwhelming bi-partisan support. This suggests the value movement in healthcare will live on. For those providers who are well down the path of value-based care, uncertainty over market conditions shouldn’t change your focus—or commitment. Outcomes are rapidly becoming the standard by which all providers are judged and the movement toward team-based care is gaining momentum. But what do care teams look like, and what roles do members play in a market where the new unit of exchange is value?

In the traditional approach, which was predominant when I was practicing, the doctor was the primary caregiver and filled nearly every medical role. In fact, we deliberately avoided hiring medical assistants because they would have added overhead costs to the practice. Of course, that meant the physician performed all the tasks that medical assistants now handle: rooming patients, taking vitals, asking questions about the current visit, performing preventive surveys for conditions such as depression, and then coordinating with the doctor for questions, prescriptions, and follow-up care. Today, we know that’s a highly inefficient—and expensive—use of a physician’s time and expertise. It’s expected now that the doctor’s role should be focused on those activities that only she or he is qualified to do: making medical decisions, communicating with patients for shared decision-making about their care, and performing hands-on procedures that require a medical license. Any other activities should be performed by the most appropriate member of the care team.

This is the key to value-based care: allowing each member of the team to operate at the top of his or her licensure, which helps to contain costs while improving efficiency and overall level of care.

In this model, the patient is at the center of the care team—active and involved with other team members as appropriate to manage both healthcare decisions and their associated costs. The care team is led by the physician, often working in partnership with another physician and sharing clinic-based resources. These physicians have population health management accountability, but are typically focused on patients with scheduled appointments or in need of immediate care. Operating between the physician and the patient are customized care teams, which service the provider, specialists, caregivers, and, of course, the patient. Today’s concept is built around the extended team, which includes medical assistants, nurses, physician assistants and nurse practitioners, and may also include care coordinators, educators, and behaviorists. Specialty practices may also have roles specific to their population needs, which can be filled by onsite personnel or by virtual team members located elsewhere.

For more about care team design and composition, read this accompanying blog article.

However, they are composed, these care teams are dedicated to overall population health as an outgrowth of one-on-one value-based care. New processes are part of the evolution for teams to engage patients and operate cost-efficiently, and technology is a significant enabler to the new team and its workflow. The electronic health record (EHR), which has widespread provider adoption, becomes the system of record. EHRs provide relevant information and documentation in support of office visits.  However, patients spend only a small fraction of their lives in a physician’s office which means EHRs are only capable of rendering a snapshot of health status and patient care. More to the point, EHRs were originally designed for data capture, not visualization or knowledge transfer, making them a transactional—rather than actionable—tool. 

Next generation healthcare IT must support workflows for office visits, but also workflows of extended team members managing the patient population between visits. Examples include Transitional Care Management and Chronic Care Management, two novel reimbursement programs designed by CMS to support the management of complex patients with multiple co-morbidities. Technology platforms that provide the glue—helping to coordinate care by connecting providers, nurses, pharmacists, therapists, caregivers, and patients—promise to improve communication, support clinical decision-making, and make more efficient the care delivery process.

Patients and providers are already reaping the benefits of value-based care. Those providers who are committed to incorporating care teams into their practice are well-positioned to weather ongoing healthcare market changes.

J. Siemienczuk, MD