Provider case studies demonstrate that involved teamwork and reengineering of frontline healthcare workers’ jobs leads to better clinical outcomes and improved patient satisfaction
Team-based care is coming to the American healthcare system. Among other things, this will create the need for clinical laboratories and anatomic pathology groups to better align how they report medical laboratory test results so that all appropriate members of a patient’s care team have timely and appropriate access to relevant lab test data.
One recent study of team-based care determined that expanding frontline workers’ roles is an effective response to healthcare industry pressures. The study was performed by the Engelberg Center for Healthcare Reform at the Brookings Institute.
Study Was to Define New Roles of Frontline Healthcare Workers
The purpose of the March 2014 study (dubbed a “toolkit” and titled “Redesigning the Care Team: The Critical Role of Frontline Workers & Models for Success”) was to define the new roles of frontline healthcare workers. It also gathered providers’ case studies about team-based care models.
The team-based care models of four providers were studied. Researchers described payoffs ranging from organizational efficiency and improved financials to staff satisfaction and community development, according to the report conducted in partnership with the Hitachi Foundation.
Team-based care responds to new delivery models, including patient-centered medical homes (PCMHs) and accountable care organizations (ACOs). PCMHs and ACOs emphasize coordinated, team-based care to ensure patients receive the right care at the right place and time, according to a Brookings blog post introducing the report.
Medical laboratory technologists fulfill important frontline responsibilities on teams. So, it is important to review the case studies and understand the lessons learned from others’ recent experiences.
Why an Emphasis on Teams and Frontline Healthcare Workers?
A team is critical to addressing the many physical, emotional and social needs of patients, stated Kavita Patel, M.D.. She is Managing Director for Clinical Transformation and Delivery at the Engelberg Center for Health Care Reform and one of three report writers.
Among the factors driving team-based care models, added Patel, are shortages of physicians and healthcare workers and the upsurge of people eligible for health insurance coverage.
“Frontline healthcare workers are also important to rounding out the care team, and they already represent nearly 50% of the estimated 18 million people employed in the healthcare workforce,” she noted.
Defining the Range of Contributors to a Healthcare Team
“We define ‘frontline healthcare workers’ as professionals that provide routine and essential services in a medical practice or health system,” continued Patel, “such as medical assistants, administrative assistants, laboratory and pharmacy technicians, community health workers, health educators and home health aides.
“Each of these healthcare professionals have a critical role in a patient’s healthcare experience because they are often the first point of contact for many patients and families and also provide basic clinical support services,” she said.
Here is a brief description of the case studies profiled in the Engelberg Center for Health Care Reform at Brookings report:
Arizona Connected Care (ACC) is a physician-led ACO and a PCMH with a Care Transitions Program. As part of the program, healthcare workers help patients transition from hospital (including Tucson Medical Center) to home with continuing care plans, in-home reviews of medications, and post-discharge reports.
The ACO’s beneficiaries number 17,000, and about 100 are screened monthly for the program. Ultimately, 30 patients participate. Medical assistants play key roles in the program by informing their teammates of patients with readmission risk and by assigning high-risk patients to transition nurses. ACC estimated that the Care Transition Program could save about $2.6 million to $4 million in high-risk ACO beneficiary care.
AtlantiCare is a health system spanning 70 locations. This case study explored the Special Care Center’s development of a team care model. Medical assistants became health coaches, which involved relationship-building and patient education, according to an online video.
Special Care Center enrollees had 41% fewer inpatient hospital admissions and 48% fewer emergency department encounters, as compared to control group members during a one-year period, a Harvard Medical School analysis showed.
Cornerstone Health Care, a multispecialty group with 18,000 employees in North Carolina, reported a redesign of the care team to control costs. Medical assistants were trained to be patient advocates and health navigators.
The advocates and navigators in the program’s first six months made 5,528 calls resulting in 1,816 appointments within a six-month window. Also, turnover of frontline workers was down 5.2%, Cornerstone reported.
Lancaster General Health, a system including Lancaster General Hospital, launched a health navigator program in April 2013 focused on Medicaid patients. Frontline workers are responsible for identifying high-risk Medicaid patients, removing them from the PCMH, and enrolling them in a care coordination program.
Also, the system redesigned career paths and created opportunities for frontline workers to advance within departments. Lancaster said its workforce redesign project cost about $2 million and improved employee satisfaction.
Retooling to Meet the Changing Needs of Healthcare in America
As providers continue to face healthcare reform’s implications, The Engelberg Center for Healthcare Reform’s toolbox offers credible ideas for transforming processes. Teams and frontline workers can help patients manage chronic illness, improve health indicators, and avoid unnecessary hospital stays.
As a distinct trend during healthcare’s evolution, it is likely that healthcare teams will work differently with medical laboratory tests and anatomic pathology services. Therefore, clinical lab managers and pathologists should be alert for new opportunities to add value. This will be particularly important as healthcare moves away from fee-for-service reimbursement and adopts different forms of value-based and bundled reimbursement.
—by Donna Marie Pocius