The model of medical care is constantly evolving. Care based on an “episodic event” paradigm has proven not to work. Episodic or acute events such as annual exams, injury, or the flu can function just fine with the standard care model, but often fail when patients require regular interventions for chronic conditions.
Most recently, telehealth visits have grown rapidly, disrupting the norm of receiving care in person in a doctor’s office. The COVID-19 pandemic significantly reshaped how care is delivered and will have a lasting impact on the healthcare system.
Healthcare systems and workers are under significant strain. Provider burnout, high employee turnover rates, and increased costs for staffing and supplies have all challenged the healthcare system in the past decade.
Emerging trends and innovations in healthcare have the opportunity to change the way care is delivered. As technology options improve, care models are also evolving. The team-based care model provides an opportunity to bring care into patients’ homes, leveraging medical technology advancements and extending the reach of diverse care teams.
What is a team-based care model?
Many times, patients only experience the healthcare system through visits to provider offices, hospitals, clinics, and other healthcare settings. Patients travel to a healthcare site to receive care. The team-based care model is defined as “the provision of health services to individuals, families, and/or communities by at least two healthcare providers who work collaboratively with patients and their caregivers to accomplish shared goals within and across settings to achieve coordinated high-quality care.”
A team-based care model operates with the patient at the center. It focuses on providing care in home and community-based settings. Team-based care decentralizes healthcare services and moves procedures like lab tests and monitoring to the home or local sites. A multi-disciplinary team is engaged with each other in a team-based care model; each member plays a key role in supporting patient care.
A patient’s care team consists of the various providers and staff that monitor and manage the patient’s health. A patient with diabetes, for example, may need a primary care provider, dietician, diabetes care and education specialist, pharmacist, endocrinologist, eye doctor, and mental health professional. Patients living with chronic diseases can especially benefit from the team-based care model and strong communication among the providers involved in their care.
Why the team-based care model is more important than ever
The US healthcare system is challenged by growing costs, increased prevalence of chronic disease, and an aging population. Treating these challenges in hospitals, provider offices, and clinic settings can sometimes result in expensive care that could have been delivered elsewhere at a lower cost. Lack of access to facilities that prioritize Care Management and preventive care leads to poorly managed chronic diseases and potentially avoidable complications. The team-based care model addresses these challenges and provides opportunities to change this dynamic. By moving from an institution-based model to a home-based model, team-based healthcare improves patient experience, reduces costs, and has the potential to improve quality.
The home healthcare market, which is focused on home and community-based services for patients who are aging and/or living with disabilities, has been an early adopter of team-based healthcare. Recent studies have shown that deploying a home- and team-based care model in home healthcare can result in 15–30% lower costs compared with hospital-based care for similar populations.
The team-based care model maximizes the ability to care for more patients, lowers healthcare costs, and streamlines and improves patient care. As the healthcare system sees rising costs, increased provider burnout, and a growing prevalence of patients living with chronic disease, now is the time for the widespread adoption of the team-based care model.
Enables care to more patients
The team-based care model is designed to reach more patients by focusing on care coordination among providers and care teams. The model also supports ongoing care coordination and Care Management, reducing the incidence of complications and potentially avoidable hospital use, which can be expensive and consume significant amounts of provider time and resources.
As healthcare settings were overwhelmed during the pandemic, providers and staff were spread thin. Even though clinicians were working around the clock to keep beds available, it still didn’t seem like enough. Some patients seeking hospital care were treated in lobbies, meeting rooms, and hallways due to the overflow of patients. Patients seeking care in the hospital were also at risk of acquiring other illnesses or infections during their stay.
While many people are still susceptible to COVID, advances in COVID treatment and medical technology make it easier to treat patients in the comfort and safety of their own homes. The team-based care model allows for coordination across providers and care teams, comprehensive management of patient data, and the ability to provide patients with high-quality care in a lower-cost setting.
With more streamlined, efficient care and role-based responsibilities, providers are able to spend more time on Care Management, and less time on administrative tasks. Patients are happier as well. Home-based healthcare is shown to result in greater convenience and satisfaction for patients, especially those who are aging or living with disabilities. This lower-cost model allows healthcare organizations to reach more patients. As a healthcare organization’s reach expands, caring for more patients also means an opportunity for increased revenue.
Implementing a team-based care model leads to lower costs for patients and healthcare providers such as hospitals and clinics. When patients no longer need to travel to see doctors or therapists, they are saving time and money while still receiving the care they need.
With the flexibility of telemedicine, hospitals, clinics, and other healthcare providers are able to see more patients in less time. When providers can see more patients, revenue increases. Providers are also able to alter their staffing model, reducing the costs of maintaining a fully staffed brick-and-mortar setting.
Healthcare organizations are also able to reduce overtime costs by scheduling providers to meet virtually with patients. New technology platforms also allow patients and providers to interact asynchronously.
Streamlines and improves patient care
The team-based care model streamlines coordination and care between healthcare providers and care teams. This is especially noticeable in managing chronic disease for the patient and their care team.
Patients with chronic illnesses have more appointments than the average person and tend to meet with many different specialists depending on their health status and needs. A team-based care model brings together a comprehensive picture of the patient’s health status through care coordination and access to patient data.
The various providers and care team members work together to coordinate the patient’s care, identify challenges to be resolved and gaps in care to be addressed, and work with the patient and their family on an appropriate care plan. This approach allows providers to go beyond treating the disease to develop care plans that prioritize patient goals. This approach truly establishes the patient as the center of their own care.
What is needed to implement a team-based care model?
As team-based care becomes more widespread, it’s important to consider what is needed to implement the model successfully. The team-based care model requires healthcare organizations, providers, and care teams to ensure the proper elements are considered and in place. These include:
- Data sharing: enabling comprehensive access to patient data from various sources, resulting in a 360-degree view of the patient’s condition, care plan, and goals.
- Effective software: supplemental tools to support care teams in establishing roles, responsibilities, and specific actions needed to manage patient health, address gaps in care, and alert care team members to issues requiring attention. Welkin Health offers a care management software built to support the team based care model.
Patient participation: engagement of patients and their families in establishing goals to inform a care plan, along with patient and caregiver education.
- Proper security: a secure Care Management platform to manage patient data and provider activity is essential to align with regulated security requirements, including HIPAA, patient protections, and the 21st Century Cures Act.
- Medical technology/Internet of Things: As innovative healthcare technology evolves, the utilization of technology specific to a patient’s condition can provide teams with additional insights into patient health and extend the care team’s reach across patients.
- Remote patient monitoring devices and procedures: deploying remote patient monitoring devices enables clinicians to monitor key indicators tied to the patient’s health, allowing for ongoing Care Management and alerting the care team when immediate attention is required.
- Team buy-in: establishing a new model requires support from the broader care team. Prioritizing a well-informed, trusting environment and allowing team members to be fully engaged is necessary for a team-based model of care to be successful.
- An investment in all of the above: the team-based care model requires an up-front investment, commitment, and coordination. Healthcare organizations that move forward with this approach will see a significant return on investment through reduced overall costs, improved health outcomes, and positive patient experiences.
A team-based care model helps provide patient-centered care
Growing costs in the healthcare system are not sustainable over the longer term. Adopting team-based care models addresses rising costs and empowers providers and care teams to serve patients in their homes and community-based settings, leading to better experiences for patients and their families.
As technology evolves and offers more solutions to enable care coordination across providers along with access to expanded patient data, moving to a team-based care model is essential. Successful implementation of the model allows care to be designed around the patient’s needs and goals. Learn more about how the right technology can help you achieve patient-centered care with our guide.