Team based care in health reform needs patient involvement

The following op-ed was published on June 7, 2011 in USA Today.

More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, “How will reform affect me?” It’s a complicated question, with a different answer for each patient. But as the law’s full effects unfold, one of the more significant changes will be in how patients interact with their doctors. This sea change became clearer in March, when the Department of Health and Human Services proposed rules encouraging health providers to operate in teams.

What will this look like in practice? A patient’s trip to the doctor might result in treatment by a clinician from the doctor’s team, perhaps a physician assistant or nurse practitioner. Getting an office appointment should be easier, and team members would be more available to answer questions and follow up with patients. This model is known as a “Patient-Centered Medical Home.”

Another variation would address the fragmented nature of today’s patient care by coordinating hospitals, primary care and specialists into networks called “Accountable Care Organizations.” Here, everyone involved would have incentive to share information, work together and be jointly responsible for the patient’s care.

The success of team-based initiatives, however, will rely on the patients themselves. And here’s the problem: Their input has largely not been sought.

Last year, the American Academy of Family Physicians released results from the first practices that were transformed into the team-based “medical homes.” Despite findings showing better quality of care, patients were unhappy with the change. Physician-columnist Pauline Chen noted in the  New York Times that many patients felt “displaced as they saw the old one-to-one doctor-patient interactions replaced with … one-to-four relationships involving not only the doctor but also a whole host of other providers.”

According to Terry McGeeney, a primary care physician who led the medical home project, “The Achilles heel of all of this is a lack of patient understanding and engagement.” Indeed, someone forgot to inform patients how their health care would change.

In its messaging, the government has sought to calm health reform skeptics by assuring them their health care will minimally change. But by endorsing team-based models, patients will need to be better informed, and policymakers and physicians, in particular, can play important roles:

  • Policymakers should do a better job preparing patients for what to expect. Inform them that they may not solely see their doctor, for instance, but other members of the health care team. Tell patients their health information may be shared among their providers.
  • Physicians also should prepare patients for changes in their health care routine. Transforming a medical practice to fit the required regulations can take years, and the process is disruptive. Involving patients and proactively soliciting their feedback can help ensure a smoother transition.

Team-based care can improve quality of care by emphasizing preventive medicine, improving communication between providers, and facilitating better management of chronic disease. Pilot studies show provider teams save money through better coordination, which reduces duplicate procedures and expensive trips to the emergency department.

We will realize the full benefits of health reform only if patients are informed and involved every step of the way.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

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