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How to Get the Most Out of Team-Based Care

Philip Betbeze, for HealthLeaders Media, September 20, 2013

Advanced practice providers can solve plenty of capacity challenges and they're critical to implementing population health strategies. But the secret to success is not having them on staff – it's in their management.

This article appears in the September issue of HealthLeaders magazine.

Hospitals and health systems are under unprecedented pressure to remove waste from healthcare, whether it stems from using too many expensive services or having high patient readmissions or poor quality. There are dozens of other bogeys out there that waste resources, but much of the waste lies in ineffective management and inconsistent approaches to care.

As a concept, team-based care has emerged as a critical element for removing waste and other inefficiencies in healthcare. It's essential for health systems that intend to deflect the effect of declining reimbursements and seek to improve patient care and quality—and meanwhile grow volumes. An important aspect of these efforts resides in the advanced practice provider group, otherwise known as nurse practitioners and physician assistants.

While most hospitals and health systems employ advanced practice providers to one degree or another, the organizations often have not invested in management of the group as a whole. Instead, many times, management of advanced practice providers is left to the individual physicians with whom they work.

That's where many problems can crop up, says James Leonard, MD, president and CEO of Urbana, Ill.–based Carle Foundation Hospital, who, in his 25-year career as both a family practice physician and an administrator, has had plenty of experience with the APP provider class.

"As we came together three years ago with Carle Clinic, we have tried to make strides of inclusion—bringing people together so that there's really one bowling shirt we all wear," he says. "This group is really involved in a new day in providing care, so they need a place at the table. This is incredibly important."

Making progress

Carle Foundation Hospital, a 345-staffed-bed regional care hospital, acquired Carle Clinic Association (the formerly independent 350-physician Carle Clinic) three years ago, and since then one of the key cultural transformations has been the management of APPs.

Until about 18 months ago, when Carle implemented the new management philosophy, training oversight and activities of APPs were based on individual physician preferences, leading to significant variation in quality and productivity. With no consistent oversight, as a group, APPs really had no voice, and compensation varied significantly within specialties and across the organization.

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