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22069c27baec2f32b385876c2039e5de-huge-daPCP's 5th annual Gregg Stracks Leadership Summit is just one month away. Led by an interprofessional training team, the summit introduces chapter leaders to PCP’s innovative leadership framework and the variety of high-impact projects PCP chapters have used to revitalize primary care. Today on the blog, meet a member of the training team, David Choi. In this blog post from our archives, David shares his experience helping his PCP chapter open the DAWN clinic. 

By David Choi

As I write this, the DAWN Clinic will open for its first patients in 18 days, two hours and 28 minutes. The leadership team anxiously buzzes around each another at our meeting where we’re tying up loose ends and generating solutions. The tangible excitement in the room is felt by all as we finish up our respective projects. 
  
At the risk of sounding cliché, it really does seem like just yesterday that our Colorado PCP chapter held the first meeting to discuss the clinic. Students of the medical, nursing, pharmacy, physical therapy, and dental schools convene at our meetings to bring change to our surrounding community, educational institution, and the greater field of primary care.
 
At one of our early meetings about the clinic, we divided into different workgroups to take on the various tasks involved in opening a student-run free clinic. It was just an idea, that became a movement which garnered the support of the Dayton Opportunity Center and the Fields Foundation. And now we are days from opening the doors of the Dedicated to Aurora’s Wellness and Needs (DAWN) Clinic to the underserved.
 
Back then, we were a group of many students from many professions. I am amazed at how little I understood about my colleagues’ professions back then – before we became a high-functioning, interdisciplinary team.  
 
As the leader of the Pharmacy and Procurement workgroup, I was tasked with obtaining all the essential items for the clinic. How was I supposed to do this? I was a second-year pharmacy student. I didn’t know what a primary care clinic needed in order to function. I remember sitting with my co-leader Katie, trying to develop a list for the clinic, we sat there thinking “exam room table… otoscope… stethoscope… cotton balls… that’s it, right?” We knew we had a challenge and that we had to overcome it.
 
We were presented with something we were not comfortable with. But as we were taught in pharmacy school and through our work with PCP, we sought out resources and contacts to help us. We started off with the WHO guidelines for primary care clinic supplies and continuously adjusted it as we compared it to other clinics’ lists. For example, after A.F. Williams Family Medicine Center provided us with the inventory list of their current supplies, we sat down as a small group to update our own list. After one week, we had a complete list. But now we had to actually find donors to give us the items on the list. We approached clinics asking if they would be willing to donate any items. They in turn referred us to other clinics and organizations. Then we were introduced to ClinicNet and Doctor’s Care. They put us in contact with the vast network they had established to get us the items we needed. A clinic that was closing in Littleton, CO, donated roughly $15,000 worth of equipment to us. When we met with the doctor to pick up the donation, he stopped us before we left and told us he believes in our cause and our initiative. It is these experiences that demonstrate what we are capable of as students and as a team.
 
The problems of the underserved community around us are within our reach, and as health care professionals, we have a social responsibility to rise to the challenge and enact change. As students of diverse disciplines, we have the combined resources to bring together the knowledge, skills and, yes, equipment and supplies necessary to care for this population. This has truly been an interdisciplinary project. While moving closer to opening this clinic, I have learned more every day about what the different health professions are capable of. Together, we are bringing change to our campus and our community.

David Choi is a fourth-year pharmacy student at University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. David has been part of Colorado's PCP chapter since 2014. During his third year of pharmacy school, he and others worked to set up a student-run free clinic at University of Colorado called Dedicated to Aurora’s Wellness and Needs (DAWN) Clinic. David aspires to bring change to the curriculum at University of Colorado to promote primary care. He loves photography and plays piano when he has time.

Read archived blog posts from other members of the summit training team. 
Kat Barnes
Victoria Boggiano
Jonathan Jimenez
Michael Mattiucci
Stephanie Nothelle
Alana Rose
Kyle Turner



 
Posted by Sonya Collins on Jul 21, 2016 3:47 PM EDT
8ab6e4087f15be4cdc51c0e79e718ef1-huge-1ePCP's 5th annual Gregg Stracks Leadership Summit is coming up. Today on the blog, PCP's president tells the story of Gregg Stracks and why the summit is named for him. 

By Andrew Morris-Singer, M.D.

My junior year of Internal Medicine residency was a difficult, confusing time. A trainee committed to a career in outpatient primary care, I found myself spending a great deal of time on inpatient hospital wards with some of the sickest, most complicated patients I’ve ever encountered. While the medical conditions were fascinating, most were preventable exacerbations of chronic problems or late outcomes of diseases that could have been caught earlier with screening. It felt like we were perpetuating a failed health care system that did little to manage and protect patients’ health but rather waited until they got really sick, and then dumped everything we had in our medical armamentarium on them. It seemed divorced from good economic sense and completely at odds with both the skills that I wanted to learn to keep patients out of the hospital and the values that brought me into health care in the first place.

Despite the dysfunction in the system, my job was to care for those patients, manage the team of house staff and students, and strike the right balance between my clinical, educational and managerial responsibilities – a significant leadership challenge for anyone, let alone someone feeling as conflicted as I was. 

My disdain for the disconnect between the care we delivered and what patients actually needed came across to everyone I supervised. “It was impossible to see this coming,” I’d sarcastically mutter to my team as we’d re-admit a heart failure patient who’d fallen through the cracks due to non-existent communication between the previous inpatient team and the outpatient providers.
 
This is how Gregg Stracks found me when he arrived to offer leadership training to a handful of residents in our program. He found someone who was overwhelmed and jaded; someone for whom team leadership meant modeling unyielding perseverance and determination, with no allowance for emotion or vulnerability.
 
“The stuff we’re seeing is so upsetting, so backwards, I’m afraid if we let any emotions out, we’ll be unable to work,” I told him at our first meeting.
 
Get done. Get out. Keep the emotions in. That was my game plan for surviving my ward time and helping my fellow residents survive.
 
One day Gregg observed our interdisciplinary care rounds on the medicine wards. The members of our large care team were overwhelmed by a particularly difficult patient and his family. We were tired of jumping through hoops to get him the best care only to be rebuffed and manipulated by him and his family. We were also frustrated with each other, convinced that members of the team from other disciplines were making the situation worse. On rounds that day, a social worker said the situation made her question going the extra mile for any patient and their family. After a long silence, to everyone’s surprise, a nurse on the team, who was typically quite contrarian, agreed with her and said she too was having a difficult time and was also questioning her values. But, concerned about “staying on track,” I interrupted and encouraged the team to focus on concrete tasks so we could “get the work done and all go home.”
 
After the meeting, Gregg pulled me aside and in his usual kind, curious, yet direct style, he asked why I had shut down the most intimate interaction he had ever seen our team have. It was the closest we had come to connecting and building real relationships with one another. Connections around values and personal experiences, he said, are the glue that binds team members together to get their work done in a sustainable way.
 
Gregg showed me that by avoiding the emotional, I was missing the opportunity to truly lead the team. Focusing exclusively on the technical and not allowing the team to publicly voice their emotions and values, I couldn’t harness the greatest motivations that had brought every member of the team into health care in the first place: commitment to helping others; to making a difference in someone’s life; to easing unbearable symptoms when there was no hope for cure. Deep connections between team members would only form when we identified our shared motivations and values.
 
Gregg taught me the importance of tapping into the heart.  He assured me that it didn’t make our team less professional. In fact, it allowed us to expand our professional selves to bring all our values, strengths and passions to our work.
 
With Gregg’s guidance, teaching and unremitting support, my notion of leadership transformed. No longer was my job about getting the work done, the boxes checked. It was about helping each team member harness the full spectrum of their intellect, passion, commitment and values for the challenge at hand. Evoking the non-technical or non-analytical wouldn’t slow us down or take us off track. Rather, it would energize us, connect us, and keep us true to the values that seemed to frequently run counter to the system in which we worked.
 
Despite the profound impact Gregg had on my approach to clinical team leadership, the greatest gift he gave me was confidence that we could take these same team-building approaches into the world of primary care advocacy to do things that many of us never thought possible. We could use this leadership style to build new teams that could push for family medicine divisions at institutions where they didn’t exist, accelerate innovation in primary care delivery, or advocate for curricular reform.
 
Many people in primary care at the time knew that we needed a new approach to advancing the field. At Harvard, my own medical school, the primary care division had recently been defunded. At other academic medical institutions around the country, primary care and its practitioners faced constant devaluation and marginalization. We needed to bring our diverse community of primary care professionals together and depart from the traditional siloed approach that only increased animosity among primary care disciplines and professions. We needed to pull average primary care health professionals or trainees out of primary care despondency syndrome. We needed an antidote to the helplessness many of us felt. Most importantly, we needed an approach that harnessed our full potential power and raised a united voice.
 
Starting in Boston, we adopted a grassroots organizing approach that essentially builds mini-campaigns to promote careers in primary care, advance innovation in care delivery and accelerate reform in training. Three years later, over 26 chapters of this network have taken root. What unites us is a commitment to building powerful relationships between individuals and using those connections to spawn action.
 
Just like Gregg taught us, we now see that when we bring a group of people together to fix a difficult problem, we must spend as much time eliciting people’s emotional response to the problem as we do their logical response to have the best chance of creating and sustaining a new team that can solve the problem. The head steers us, but the heart is the engine that makes us go. Just like I discovered on the wards, our job as primary care leaders is to create spaces where like-minded individuals not only can brainstorm solutions to the problem, but where they can express and subsequently harness their emotions and values as well. 
 
Sharing ourselves with others and inviting others to do the same is at the heart of PCP’s effort to lead change in primary care. In my travels around the country and my communication with many of you, it warms my heart to see this leadership approach manifest in all of your great work. Your commitment to this practice has grown the network. Others join us not because their heads tell them to, but because their hearts compel them to.
 
As one faculty member recently confessed to me while we were watching a group of interprofessional students share their values and experiences at a PCP meeting, “It’s not only inspiring to watch this…it’s totally intoxicating.”
 
Gregg Stracks passed away in January of 2012, at the age of 40, from metastatic ocular melanoma, years after he had been told he had months to live. All of the work we did together – all of which occurred after he was suffering from metastatic disease – was the greatest gift I’ve ever received.
 
I believe two things helped Gregg survive so long. First, the deep love, devotion and companionship of his wife Sara and his family and friends. And second, his work with Primary Care Progress and others, helping people like me share our emotions and values and exercise our responsibility to enable others to do the same. Simply put, Gregg was energized by helping people connect with one another. It helped him survive and helped spawn a primary care movement.
 
Gregg’s passing was a great loss to everyone who knew him. He took a piece of our hearts with him, but he left a piece of his heart with us, too. He left us with an approach to leadership, connecting with others, understanding ourselves and building teams that can help each of us do our best work during whatever time we’re lucky enough to have in this life.
 
Please join me in reflecting on our collective luck at being a part of a network and movement connected to such an amazing person as Gregg Stracks, who gave so much of himself, at such a difficult time. Let’s commit to using his leadership summit to reconnect with the values that brought us into primary care. Through those values, we can connect with one another to build new visionary teams to fight for the health of our patients,  our families, our communities, and this nation.
 
Andrew Morris-Singer is a physician and former community organizer and trainer. As president of Primary Care Progress, Dr. Morris-Singer has been instrumental in igniting an interprofessional trainee-led grassroots movement to reform primary care delivery and training.  Dr. Morris-Singer writes and speaks regularly on the topics of primary care community advocacy, utilizing organizing strategies to advance primary care clinical innovation and the critical role of trainees in the revitalization of primary care. Dr. Morris-Singer is board-certified in internal medicine and is an affiliate instructor at Oregon Health and Science University. He lives in Portland, Oregon.

Read more about the Gregg Strack's Leadership Summit.
 
Posted by Sonya Collins on Jul 14, 2016 2:17 PM EDT
50d194de2607f04f2fe9a65d50bcb085-huge-unPrevention and multidisciplinary teams are the cornerstones of a transformed primary care system. Today on the blog, Dr. David Moen explains how TeamMD is putting these values to work to keep the elderly on their feet.

By David Moen, M.D.

Rose was 83, lived alone, and came to the ER by ambulance around 11pm.  She had fallen earlier that day and was unable to get up.  Over the next few hours, she slid to the phone and finally dialed 911.  When I met her, she complained of severe right hip pain and exhaustion but not much else.  I didn’t find much in her history or exam: mild cognitive impairment, mildly elevated blood pressure, and a tender right hip with no swelling or bruising anywhere.  I ordered some labs and x-rays. 

During her ER stay, she became a bit agitated.  She wanted to go back home.  I didn’t think that would work.  She couldn’t stand by herself.

I needed an admitting diagnosis to solve “my problem.”  Her hip x-ray was normal.  A broken hip would be an “easy admission” for me as an ER doctor.  Medicare wouldn’t pay for a ride to her apartment, no family responded to our calls, and no home care was available at this time of night.  Her blood work was normal.  “Fortunately” for me she had bacteria and some white blood cells in her urine (like most women her age).  Rose was admitted with intractable hip pain, possible UTI, and cognitive decline. It seemed to be the only and best option.

Rose never returned to her beloved apartment.  The night I admitted her, she became more agitated and confused.  She was experiencing delirium, just like 65 percent of all elders with any cognitive impairment admitted to a hospital.  That night she fell and struck her head.  A CT scan showed a subdural hematoma.  Then she aspirated, developed pneumonia, and after a 12-day hospital stay, she was sent to a nursing home.  Rose died 183 days later (an average-length nursing home stay). 

The hospital quality review committee determined that the night nurse “wasn’t watching Rose closely enough.”  The night nurse was reprimanded for what most of us would admit is a broader system failure.  She felt terrible and quit working nights a few months later.

Patients like Rose inspired me to imagine that there might be something better.  Can we find the Roses at risk for falls and illness exacerbations in our communities before the crisis?  Can we build a team that responds to their needs proactively and prevents them from the dangerous and sometimes deadly trips to the hospital?  If so, how do we do that efficiently and how do we pay for it?

In fact, 16 percent of Medicare recipients spending over 70 percent of all funds are at risk for unanticipated hospitalizations due to falls or worsening chronic conditions.  We can find them before the crisis, and when we build a team responsive to their needs 24/7/365, they live longer and happier lives, and cost us all over 25 percent less.  And we can pay for it by combining physician fee-for-service revenue, care management revenue, and quality incentives for quality and cost performance.

United Health Care’s Venture Capital Team recently funded TeamMD to be there for the Roses of the world.  Modeled after a successful Minnesota company named Genevive, TeamMD provides exceptional primary care and comprehensive care management for frail, and mostly poor, elders.  Given Genevive’s track record in Minnesota (exceptional patient and family satisfaction, high physician and staff satisfaction, and lower costs of care), TeamMD has a high likelihood of success.

TeamMD started in its first outside-Minnesota market (Des Moines, IA) on January 1. The Iowa program now serves over 1,600 patients living in nursing homes, assisted living facilities, and their own homes. Its growth has been fueled by committed nurses, social workers, doctors, nurse practitioners, and support staff passionate about serving this “underserved and over-serviced” patient population. Recruiting clinicians hasn’t been as difficult as anticipated. That’s because well-supported clinicians and support staff find great reward caring for this challenging population.

So what makes it work? Well-trained and supported clinical teams that are paid more than clinic doctors (due to aligned payment model) find the right patients in the community sooner rather than later, answer the phone when it rings, and provide multi-disciplinary care planning for every patient and family before, during, and after each crisis.  This is a model that could be implemented in many communities across America.  It proactively addresses the physical decline, cognitive failing, and social isolation that plague many as we age. It emphasizes prevention and the value of a multidisciplinary team.  Falls, injuries, and worsening chronic conditions are more proactively and holistically addressed.  That keeps elders in their homes and prevents hospitalizations and nursing home stays that cause harm.

Our leadership team is partnering with health system leaders across the country to improve the lives of these patients.  We will reach many markets, attract the best and brightest to execute our mission, and enhance training opportunities and job growth in the markets we serve.  And the Roses of the world will get better care and live happier and longer.  To learn more, see www.TeamMD.com.  If inspired, come for a visit to learn more!  Thanks, Rose!

David Moen, M.D., is a health care consultant and board chairman of TeamMD.

Read more about team-based care.



 
Posted by Sonya Collins on Jul 7, 2016 10:02 AM EDT
06614882f36d8f07c225c12d98e4d6db-huge-5dPre-meds might get more excited about primary care if they saw it as a way to help achieve social justice.

By Phillip Zegelbone 

If we hope to improve our health care system, I believe we must motivate pre-med students to take an interest in system reform. The fresh outlook, optimism, and intellectual curiosity of young doctors-to-be are essential for progress.

Case in point: As an undergraduate at Wesleyan University, my classmates and I were inspired by the ideas and experiences we shared in a public health course offered by the sociology department: the Health of Communities (HoC). In HoC, our professor assigned each of us an internship in a community health clinic. We met in class to compare our progress in the internships and to discuss assigned readings. When the course ended, we felt the need to create a Health Care Action Network (HealthCAN) out of a shared desire to promote social justice in health care. 

Most students enrolled in HoC to learn about using social change to assist vulnerable populations. We entered the course with the notion that our contemporary models of care did not meet the health needs of vulnerable populations. Interestingly, only a few students were pre-meds or science majors.

At the beginning of the course, we believed that anyone who couldn't afford care could get it in the ER. We had no idea how difficult it can be to access care in the United States. None of us knew anyone bankrupted by health care bills and none of us had played a role in a clinic beyond shadowing. As we learned how our health system falls short, we were angered by the major obstacles patients and providers face and were frightened to learn of the major shortage of primary care doctors.

I think the real success of HoC was in translating our negative reactions into positive actions. We read case studies of social injustice in medicine, then worked toward solutions in our internships. This was my most productive period in college. The mentorship we received in our internships filled an important void and probably saved us all from feeling estranged from medicine.

The following semester, many of us continued our internships and wanted to maintain the discussion forum that had evolved in HoC, so we founded HealthCAN. Our goal was to increase student awareness of the barriers to health care access in the United States. We screened documentaries, hosted speakers, and distributed health care platform leaflets during the 2007-2008 election season.

Our group soon became politically active. Many of us had learned about single-payer health care from a HoC presentation by Physicians for a National Health Program (PNHP) and were struck by the large, and possibly needless, overhead expenditure of the private insurance industry. In our first HealthCAN meeting, I brought a PNHP activism toolkit to the table and we decided to canvass for single-payer insurance. This popular effort paved the way for my favorite HealthCAN event, in which a speaker from PNHP facilitated a lively discussion about the single-payer system. The event was widely attended and brought in many new members.

Presently, the majority of the original HoC students study or work on social justice in health care. My involvement with HoC and HealthCAN has inspired me to pursue primary care, as I now see primary care as a critical frontline in improving access to health care. More pre-medical students would tackle the problems in primary care if they knew they could gain the inspiration that my HoC classmates found in their internships and that HealthCAN members experienced with political canvassing.

When Phillip Zegelbone wrote this post in 2011, he worked in the MIT Chemistry Department as a Laboratory Manager. He has since completed medical school. 

Read more about social justice in primary care.

Posted by Sonya Collins on Jun 30, 2016 2:35 PM EDT
94078582e45dc42522cd3a8c1c3611b6-huge-clIn this team-based clinic, teammates prevent burnout by lighting the way for each other. A family medicine resident tells us how it works. 

By Cleveland Piggott, M.D., M.P.H.
 
Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door! – Emma Lazarus (inscribed in a bronze plaque on the pedestal of the Statue of Liberty).
 
Part of the reason I chose primary care, and family medicine in particular, is my desire to be the lamp to those in need. Whether they need inpatient care, help with their chronic disease, a minor procedure, or just someone in their corner, I'm in a position and have the skill set to provide those services to my patients. But without a team, my lamp would burn out fast.
 
Being a member of a team is part of what makes my job as a physician so rewarding. I feel lucky to be training at a clinic that is pretty close to being my ideal work environment.
 
I work at AF Williams Family Medicine in Denver. Our medical assistants (MAs) are some of the best trained in the city. Not only do they help with vitals, but they take and document histories from patients based on the patient's chief complaints and associated question prompts in our computer system. They also identify gaps in the patient's recommended health maintenance and help close them so that the burden doesn't fall completely on the provider. After a quick huddle with the provider, the MA and provider enter the room together where the provider is able to focus more on the patient while the MA assists with real-time charting. Since the MA is already in the room, they are able to complete post-provider visit tasks, such as scheduling and blood work, without making patients wait or go somewhere else in the clinic to have this done. Providers are more present during the visit, so patients can form stronger bonds with both providers and MAs. 
 
To be successful, this model requires more MAs and a lot of upfront investment to train them. As a trade-off, providers must increase their daily patient visits but often are able to leave the office sooner due to the decreased time spent with documentation.
 
This model of care has been dubbed the Awesome Patient Experience (APEX) model and has increased our clinic's quality of care, patient satisfaction, access, and provider satisfaction.  
 
What makes this model even more rewarding for me is the other amazing team members I get to work with on a daily basis in our Patient Centered Medical Home. They allow us to provide a much broader scope of care to our patients so that we can truly meet their health needs.
 
Need an X-ray, blood drawn, or a vasectomy? We’ve got you covered. Struggling with paying bills? Let me grab our social worker to provide you with some resources. Your depression is affecting your marriage? I think our certified marriage counselor is in today, and I'll be happy to do a co-consult with our behavioral health team at your next visit. Pregnant while on seizure medication? Let me grab our pharmacist, and yes, I look forward to delivering your baby. Need a quadruple bypass surgery? Refer! 
 
I'm proud to be part of a team providing this level of care to a diverse and complex patient population. I look forward to seeing our clinic blossom as we continue to hire and train more staff to maximize the APEX model. There have been and will be growing pains, but aren't there always? No surprise, our hospital CEO has taken notice and wants to expand this model to more clinics.
 
This is the model of care in which I always envisioned myself practicing. A few years ago during residency interviews, a faculty member asked me where I saw myself five to ten years after residency.  I said, “A part of a happy, high-functioning team where members work at the top of their license to provide exceptional holistic care to patients from all walks of life.”
 
But I didn't have to wait five or ten years.
 
Cleveland Piggott, a graduate of the University of North Carolina School of Medicine, is a resident at the University of Colorado Family Medicine Residency. His interests in health care include policy, primary care work force, mental health and academic medicine.

Read more about team-based care. 
 
 
 
 
 
 
 
 

 
Posted by Sonya Collins on Jun 23, 2016 11:29 AM EDT
Sonya CollinsHere on Progress Notes, many health care providers have written about the value of team-based care. It allows health care providers of all disciplines to practice at the top of their license, doing what they do best and freeing up more time to spend face-to-face with patients. Team-based care also allows for payment models that incentivize quality of care over quantity of care. That's why providers like it, but what do patients think? That's what we wanted to find out. 

By Sonya Collins

Ridie Ghezzi was dealing with depression. Her doctor tried her on one medication, then another, then changed her dose, but it just wasn’t working for her. So she called Amanda Rice, the behavioral health specialist at Dartmouth Health Connect in Hanover, NH, where Ghezzi is a patient.
 
Rice immediately contacted Ghezzi’s primary care doctor – also at Dartmouth Health Connect – who called Ghezzi that day. The phone conversation was long and unhurried. During the call, the doctor decided to change Ghezzi’s prescription, and she made an appointment to meet with Ghezzi, her health coach, and the behavioral health specialist as a team the next month.
 
“I felt like the wagons had surrounded me in protection,” Ghezzi recalled.
 
TeamworkA same-day call back from a doctor? A long phone conversation? An appointment with three health professionals in the room at the same time? If this doesn’t sound like a typical interaction with the health care system, it’s because Dartmouth Health Connect is not a typical clinic. Its team-based model of care strikes a stark contrast to the solo doctor-does-all, seven-minute-visit model that most patients know (and few love).
 
By design, team-based practices, also called patient-centered medical homes, have the potential to redistribute provider workload, change the way health care providers get paid, and – in the best cases – put patients at the center of it all. Providers have many reasons to love the model of care, but what do patients think?
 
Research shows that patients want four things in a medical practice: whole-person care; coordination and communication among providers and between providers and patients; patient support and empowerment; and ready access.
 
If a health care model by any name delivers those benefits, patients are likely to take to it. “Patients love the concept, but if it’s not operationalized, if the practice isn’t visibly operating as a team, they won’t embrace it,” said Christine Bechtel, co-chair of the Center for Patients, Families and Consumers at the Patient-Centered Primary Care Collaborative. Bechtel co-authored the aforementioned research published in 2010 in Health Affairs.
 
What is team-based care?
 
The idea behind team-based care is that doctors cannot – and should not – do it all. They can’t see all the patients, solve all the problems, and complete all the associated administrative tasks in a day’s work. Even if they could do it all, they’re not always the best one for the job. Doctors diagnose, but pharmacists unravel complex medication regimens to discover which one is causing the unpleasant side effects. Dietitians help patients come up with a meal plan to achieve a healthy weight or manage their diabetes. Behavioral health specialists address the mental and emotional issues that may prevent us from achieving optimum health. Sure, doctors can refer patients to these and other specialists, but patients don’t always follow through. And when they do, the referring doctor may never know what happened during the visit.
 
Team-based care can bring multiple health care providers together under one roof, or it can include a care coordinator who quarterbacks care that happens in multiple settings. Team members can free up their teammates to do what they do best, whether it’s diagnose, manage medications, or optimize a diet.
 
“It’s not about a doctor just writing a prescription and telling you what to do,” said Amy Gibson, RN, who is chief operating officer of the Patient Centered Primary Care Collaborative. “It’s about bringing [providers] together as partners who can provide expertise. At any given point in time, it may be the behavioral health specialist or some other team member besides the physician who needs to be leading that team.”
 
Placing patients with the most appropriate health care provider, rather than the doctor every time, can also increase access to all providers for all patients. That’s why some team-based models may offer same-day appointments, email and telephone access to providers, and longer appointments. Team-based models may also allow for innovative payment structures. For example, payers might reimburse practices a flat monthly fee per patient rather than a fee for each service provided.
 
When it doesn’t work
 
Simply declaring a practice to be “team-based” is not enough to convince patients. Bechtel selected her current primary care provider because it was a team-based clinic. She has been a patient there for several years now. But every time she goes, she says she feels like a new patient that no one knows. She fills out paperwork for the receptionist, who asks her why she is there. She then sees the medical assistant (MA), who takes her vitals and asks her why she’s there. The MA then leaves her with a doctor, physician assistant (PA) or nurse practitioner, who again asks her why she is there.
 
Stethoscope“Where is the team part of this? I’ve just been asked why I’m here three times,” Bechtel said. “It’s so obvious to patients when they’re not operating as a team.”
 
For patients, a team-based model like this one just seems to place more barriers between their doctors and themselves.
 
“Oftentimes, what patients observe, unfortunately, is that they can’t get to their doctor because it’s ‘team-based,’” Bechtel said. “They ask, ‘Well, what does that mean?’ And the practice tells you it means that all providers can access the medical record and read each other’s notes. But that’s not a team.” Shared access to an electronic medical record may streamline the workflow for providers, but it’s not necessarily a visible improvement in the patient’s experience.
 
Even the best intentioned team-based clinics may not get full buy-in from patients if patients don’t know what team-based care is. Patients need to be fully oriented as to what the new model offers, what issues it addresses and how patients can make the most of it.
 
“If no one ever explains to patients what a team-based approach is, that you might sometimes see a different person, but that person is always going to know what’s happening with you and has full access to your doctor and your records,” Bechtel said. “If no one ever says that, the patient experience isn’t going to be good.”
 
When it works
 
Team-based care that works puts the patient at the center and addresses the patient’s needs and concerns ahead of those of the provider or payer. “We haven’t done such a good job of knowing and engaging our customer in health care, and we’re trying to make that happen through the patient-centered medical home,” said Gibson.
 
Whether patients like Ghezzi can cite precisely those four things that research says patients want, the way she describes her experience reflects these values. Her physician teamed up with the behavioral health specialist to address her complaints as a whole person. The providers communicated with each other prior to contacting her and then engaged her in a conversation with them during a group appointment. The quick call-back demonstrated their support for her and her ready access to them.
 
“Everyone is working together, recognizing that none of these things are separate from each other. Emotional and physical are interconnected,” Ghezzi said. “And you feel, by the kind of care they give, that it’s all being worked on as a whole.”
 
Is a rose a rose?
 
Many medical practices can call their model team-based, but that doesn’t predict what the patient’s experience will be. At the same time, whether or not patients even know the name of the model, they will know whether their health care providers are working together as a team with the patient at the center.
 
“If you build it will they come?” Bechtel asks in the title of her 2010 Health Affairs article on team-based care. The answer, she says, is “if you build it with them, they will already be there.”

Sonya Collins is an independent journalist who covers health care and scientific and medical research. She is the editor of Progress Notes

Read more about team-based care.
Posted by Sonya Collins on Jun 9, 2016 3:39 PM EDT
5aaf45f1eb68256d210bf8a2cee92712-huge-45Today on the blog, Daniel Gordon -- a med student when he wrote this and now a physician -- shares what drew him to family medicine.

By Daniel Gordon, MD


I grew up as a patient of family doctors in Hartwell, Georgia, population 4, 287. My hometown had zero specialists, so my %uFB01rst exposure to medicine was through our family physician.

The waiting room at Dr. Stone’s office was one of the most diverse places I had ever been. The patients were young and old, black and white, and I liked this. In the exam room, I studied a model of the spine and Dr. Stone’s tools.

As soon as Dr. Stone came into the room, he’d always make me laugh.

I don’t remember the reasons for these childhood visits, but I remember that he always made me (and my parents) feel comfortable and open – and better.

more...
Posted by Sonya Collins on Jun 2, 2016 2:12 PM EDT
87662f71c032c50632bb111cc91cc593-huge-leAs team-based models of primary care become more prevalent, you may encounter health care professionals you've never heard of before.  For example, what's a health coach?  Here -- in a post from our archives -- is an explanation from C. Leigh Goldsmith, who was a health coach at Iora Health's Collective Primary Care in Brooklyn, NY.

By C. Leigh Goldsmith

The patient tracking system lights up my laptop with “WAITING.”  I head out to the waiting room to meet “Angela” with a smile and a handshake.  She stands up from the sleek gray couch. Light streams into this magnificent space that is so rare in New York.  Angela has red pixie hair and thick black hipster glasses covering pensive eyes.  She gives me a smile, big but sad. 
  more...
Posted by Sonya Collins on May 26, 2016 11:36 AM EDT
adde7675af24249cb43282150ef6d77a-huge-khHere on the blog, we've been taking a closer look at team-based care. This psychology student learned that crucial members of the care team were right outside her door. Here she explains the value of team-based care and integrating behavioral health into primary care. 

By Linda Khatib

I treated “Tina” in an intensive outpatient program for psychological services. She was one of many patients I have treated who struggled with countless comorbid chronic conditions, both physical and mental. Specifically, Tina struggled to cope with bipolar disorder, diabetes and obesity.
 
Throughout the course of treatment, I tried my best to provide her with the greatest care possible, but I felt helpless because psychological treatment was not enough. I was able to help Tina recognize and acknowledge her maladaptive eating behaviors. We also worked together to gain a better understanding of her addiction to food, which was due to underlying traumatic experiences she faced during her upbringing. Although she was able to reach this pivotal point in therapy, I felt she needed more to see improvements in her overall life. One of her goals was to lose weight and better manage her diet, so I searched for a nutritionist who would see Tina to further address her diet needs and help her choose healthier foods. In addition, the nutritionist could better meet Tina’s needs for managing her diabetes and losing weight. 
  more...
Posted by Sonya Collins on May 19, 2016 11:14 AM EDT
47c84d1864ff0bf6a177754787d2de4f-huge-scA family medicine resident learns from her mentor that educating patients is the most important thing a doctor can do. 

By Patricia Martin, D.O.

My mentor recently went on maternity leave after the birth of her second child.  I quickly noticed the absence of her calming presence around our frenetic health center on the west side of Chicago.  I also noticed how in her absence I started to feel a little more overwhelmed by the day-to-day stress of our practice.  I began to reflect on how her presence and guidance had shaped my experience as a family medicine resident thus far.  She had been lighting the path for me, and when she first left, it was as though someone had abruptly turned off the light. 

  more...
Posted by Sonya Collins on May 12, 2016 11:17 AM EDT
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