Why Are Care Teams Essential to Your Health System or Hospital?

Team-based care has many benefits for patients and healthcare providers.

Health systems and hospitals should be doubling down on team-based care, a pair of chief medical officers say.

In a recent position paper, the American College of Physicians stressed the importance of physician-led care teams. Team-based care models have been linked to good patient health outcomes and better healthcare-professional collaboration.

Healthcare has reached a level of complexity that calls for a team-based approach to care, says Brad Archer, MD, CMO of Monument Health.

"The complexity of navigating an increasingly technologically advanced medical system requires more than an individual physician or traditional doctor-nurse team can provide," he says.

Team-based care takes the doctor-nurse dyad to the next level, effectively engaging a variety of healthcare professionals, including advanced practice providers, social workers, clinical pharmacists, therapists, and back-office staff, says William Agel, MD, MPH, CMO of Cape Cod Hospital and Cape Cod Healthcare.

"Healthcare is the ultimate team sport," he says. "There are many benefits of team-based care. For the patient, they get the broad and deep talents of a group of professionals working together to get them well and keep them well. For providers, team-based care allows for the distribution of tasks and complementary skillsets that reduces administrative burdens, lowers burnout rates, and improves job satisfaction as everyone works at the top of their licenses."

CMOs need to be focused on team-based care, Archer says.

"Ultimately, CMOs are charged with allocating increasingly scarce resources for patients over increasingly more complex technological offerings," Archer says. "We have talked for years about providing the right care to the right patient at the right time. In most cases, there is no individual who has the capacity and the breadth of knowledge to focus holistically on patients. So the CMO must rely on teams to provide care."

Care team leadership

In most cases, care teams should be physician-led, Archer and Agel say.

That's the case at Monument Health. The health system participates in a Medicare accountable care organization and other value-based care arrangements, which use attribution to physicians for looking at data, so physician-led care teams make sense, Archer says.

Physician-led care teams also fit well with patients' perceptions of who is in charge of their healthcare, he says.

"Ultimately, we want a captain of the ship in place to help guide care, and physicians are well-suited to that role," Archer says. "The coordination of care needs prioritization. Physicians are the best trained healthcare professionals to be able to know how to prioritize care coordination needs."

Care teams should be led by the individual most qualified to attain a positive outcome for the patient, Agel says.

"In most cases, that is going to be a physician, who is the person with the most training and the most authority to diagnose and treat a problem," he says.

There are circumstances where a nurse or an advanced practice provider, such as a nurse practitioner or physician assistant, can take on the responsibility of leading a care team, Archer and Agel say.

"For nurse practitioners or physician assistants to lead care teams, there needs to be clear and concise guidelines," Archer says. "You should also have a patient population that has been pre-selected. The goal should be to gain adherence to the guidelines for the betterment of the patient's health. Those situations lend themselves well to having advanced practice providers leading teams. However, when there is diagnostic uncertainty or multiple problems that are contributing to a patient's overall health, it is best to have a physician leading the care team."

An advanced practice provider or nurse may have a particular area of expertise, such as coordinating the care of a patient or navigating a patient's experience through diagnosis, that makes them good candidates to lead a care team, Agel says.

"An advanced practice provider may know the patient perfectly well in the primary care setting and know the patient better than the physician does," he says. "In that case, the advanced practice provider is probably better able to guide the care of the patient, with the help of every member of the team including the physician."

Team-based care at Monument Health and Cape Cod Healthcare

The approach to team-based care at Monument Health is focused on three principles, Archer says.

• The health system has embraced a culture of team-based care that is supported by participation in a Medicare accountable care organization as well as the need to manage the health system's own self-insured employee population.

• Monument Health care teams define roles based on team members functioning at the top of their licenses.
   
• Care teams address workflows and the needs of the patient outside of the care team. For example, care teams play a key role in addressing the social needs of patients and have a master list of resources that they can make available to patients.

Cape Cod Healthcare also deploys teams across the continuum of care, Agel says.

On the outpatient side, the health system's patients have a medical home in the primary care physician space that features a team-based approach to care. In another example, there is multidisciplinary care for cancer patients.

"On the inpatient side, our obstetricians and nurse midwives work side-by-side with our pediatricians, nurses, and social workers to provide wrap-around care and support for families," Agel says. "Our general cardiologists work with our interventional cardiologists, nurses, and advanced practice providers in a heart-team approach to optimize the care of our cardiac patients. Our surgeons, surgical subspecialists, emergency department staff, hospitalists, physical therapists, and nurses provide care for our trauma patients."