What Does Team-Based Care Mean for Patients?
Expanding Rapidly with Push by Medicare
Editors Note: There are over 360
Accountable Care Organizations working with Medicare to provide
higher-quality coordinated care for seniors. Doctors, hospitals and health care
providers establish ACOs to work together to provide better health care, while working to
slow the growth of health care cost.
By Jessie Gruman,
President, Center for Advancing Health
Jan. 16, 2014 -
Have you heard that soon most primary care in the U.S. will be delivered
by teams? Yep. Team-based care is one of the characteristics of the
patient-centered medical home, a way of organizing the care of patients
that allows primary care clinicians to see more patients in a day while
at the same time delivering better care.
This move toward team-based care started long
before health care reform and was embedded deeply into the Affordable
Care Act through its support for patient-centered medical homes and
Accountable Care Organizations. It has been endorsed by the
professional organizations of
our primary care clinicians. There is a lot of activity directed toward
making this the way most of us receive our regular health care.
What does this mean for us?
It's not clear. The growing literature on team care
focuses mostly on the skills that primary care clinicians, professionals
and office staff must learn and the changes
they must make to deliver care as a team: how they should be
trained, how the workflow is
organized, how the group is led, how to build cohesiveness and trust
within teams, how team members should communicate,
How team care will affect us directly is sparsely
described, but when it is, it is common to find promises that teams will
coordinate our care among different settings (different specialists and
hospitals, for example), that teams will pay more attention to helping
us learning how to care for ourselves, and that we will have greater
access to team members who can answer questions and help us solve minor
problems. In a few
papers, reference is made to "patients and families being
members of the team."
Recently, I was asked to make some remarks about
team care at a conference. Now, I have heard from a number of people
over the years about their experience of being cared for by an oncology
or cardiology team during cancer treatment or after a heart attack, for
example, and they thought it was great being able to call the nurse, for
example, and get quick, useful help. But I hadn't as yet heard much
about people's experience with primary care teams.
So I asked ten people (regular ones, not health
care experts) I encountered over the course of a couple weeks what they
thought about the idea that "your regular health care would be delivered
and coordinated by a team of people your doctor and nurse and maybe a
pharmacist and social worker and others, not just your doctor" meant for
them. (Tiny sample, not representative, I know.)
Their comments clustered around three themes:
1) People were concerned that a team would
make getting care less personal:
"Team care doesn't sound good. I just want my
doctor to take care of me. I think this team care thing would get in the
way of that."
"What, now they want me to know all these other
doctors and nurses and aides and other professionals and to figure out
that I have to call this one for this question and that one for that
question? It's bad enough as it is. Sounds like the management
consultants are running the show."
2) People were puzzled about what difference
being cared for by a team would make.
"I'm a member of Kaiser Mid-Atlantic so I suppose
I'm treated by a team. You'd think they would look at me as a whole
person but I still go off to see the foot doctor and the hand doctor and
the heart doctor and the only thing they share is my electronic health
"You know, they might have team care already for
all I know. No one wears a name tag or tells me who they are or what
their job is. I just shuffle around wherever they tell me."
3) I asked them whether they thought they and
their spouse or someone else they chose should be members of the team.
"I don't think I should be a member of the team,
but I should have the final say about my care."
"Are you kidding? I don't know what they know and
all those different specialists and nurses talking about my problem?
Nah. They have to organize it for me."
I too am puzzled about what team care means for us.
When and why as a patient, doI need team care and what do I
need to know about it?
Here are a few questions I and many of my fellow
patients would like answers to:
First and foremost: Will I do better if my care is
delivered by a team? Will my chance of having a good outcome improve?
This is what I value. This is the bottom line.
And then, will my experience of my care be
better will I be more likely to participate in putting together a care
plan that is realistic and acceptable to me if I work with a team? For
Will I have less contact
with my trusted physician or will team care strengthen our relationship?
Will team care afford me
greater opportunities to understand my health problems and discuss my
choices about treatment?
Will team care mean there
are more "rules" for me to follow to get help from my doctor? More
Will team care make it
easier for me to get answers to my questions/prescription
Will my team coordinate
my care so I don't have to?
I don't know the answer to these questions, but I
can see that team care has the potential to affect positively or
negatively both the outcomes of our care and our experience of it.
If shifting to team care means that our care will
improve, why not tell us how. Explain (again and again) what we should
expect from our team and help us understand how to take full advantage
of the change. This is one way for teams to hold themselves accountable
for their promises: tell us your goals and then ask us if you're meeting
And should we consider ourselves members of the
team? Don't assume: ask for our preference.