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Care Redesign: Leveraging Team-based Care Models for Behavioral Health and Social Needs

Posted by Anonymous at 9/7/2017 1:29:56 PM

In Healthcare, Teamwork Makes the Dream Work

Care Redesign: Leveraging Team-based Care Models for Behavioral Health and Social Needs

By Doug Bennett, contributor

Of the many changes envisioned as part of the evolution toward patient-centered primary care models, perhaps none offers more promise for improved outcomes and reduced costs than team-based care delivery.

Team-based care is defined by the National Academy of Medicine (formerly known as the Institute of Medicine) as “…the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high quality care.”

Bifurcation of care impedes outcomes and increases costs

It is increasingly recognized that a small subset of individuals account for the majority of health care spending. These individuals often grapple with multiple medical, behavioral health and social challenges, which can result in costly—and often ineffective—interactions with the health care system. Research shows that patients who have high levels of emergency department and hospital use often have had life experiences that directly impact how they interact with health care providers, e.g., early-life trauma or family instability.

Yet patients struggling with complex physical and behavioral health needs, such as substance abuse, psychiatric disorders, Alzheimer’s and vascular dementia generally require more in-depth and continuous treatment models than the fragmented type of care available in most primary care settings.

The strong influence of economic and social factors—such as income, education level, social connectedness, housing or employment status, and reliable access to food—among these high-cost patient populations is widely acknowledged among physicians and other health care practitioners. However, very little has been done until recently to ensure that these patients—sometimes referred to as “super utilizers”—receive the appropriate social and preventive health services they need, as opposed to more expensive, and often less effective, hospital-based services.

Team-based care to the rescue

New approaches encourage the simultaneous treatment of psychiatric conditions, such as depression or anxiety, and medical conditions such as diabetes or COPD, using coordinated teams of primary care and behavioral health providers. The team-based care model is aimed at preventing situations in which the treatment of one chronic condition lessens the effectiveness of the treatment of another.

Some collaborative or team care models strategically use psychiatrists to provide consultations to primary care providers, focusing on patients who have more serious forms of mental illness and are stalled on making progress. A review of 79 research trials documented that this approach significantly improves anxiety and depression outcomes, compared with standard primary care models. This approach is designed to prevent cases in which one poorly controlled chronic condition reduces the effectiveness of the treatment of another condition.

The integration of behavioral health and substance abuse services is still relatively rare because there is little or no administrative or financial incentive to bring together standalone primary care operations. Separate provider networks, record-keeping requirements, billing and coding practices and medical training—all pose a hindrance to better integration of behavioral health and medical services for patients.

Despite these historic obstacles to care redesign, progress in integrating behavioral health and primary care models is occurring. Surveys have revealed that close to 80 percent of primary care providers who have integrated behavioral health services into their medical practices have relied on grants and/or funded the initiatives themselves. Other pioneers adopting this patient outcomes-oriented approach have taken advantage of Medicare and Medicaid demonstration projects and waivers that allow them to accept payments for providing both types of services.

Some health systems, like Boston Medical Center, have already decided to foot the bill for adding patient navigators, social workers and psychiatric nurse practitioners into their family medicine practices on a trial basis. Their rationale is that the up front investment eventually will help them succeed in acquiring future value-based contracts, or to become an accountable care organization, which can accrue savings from improving patient outcomes and reducing costs.

Don’t stand on the sidelines any longer. Become a physician who plays an active role in shaping the future of health care delivery and patient outcomes. Take time to browse through the Merritt Hawkins jobs database, which features physician openings of every type and stripe, in a variety of places and work settings. Then, contact one of our professional recruiters today to discuss next steps.


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