Adam Roise, MD, MPH Northeast Iowa Family Medicine Residency Program Jauch Symposium 16 May 2014

1. Medicine’s Future: Team Based Care Adam Roise, MD, MPH Northeast Iowa Family Medicine Residency Program Jauch Symposium16 May 2014 I have no disclosures to report.

3. This presentation will explore the delivery of patient care Patient care is becoming more complex Physician led teams provide a platform for required care delivery Working in teams requires new thinking and skills

4. Patient care is becoming more multifaceted 1958

5. Medical knowledge, diagnostics, and treatment options continue to grow and become more complex http://jasonpriem.org/2010/10/medline-literature-growth-chart/

6. Medical knowledge, diagnostics, and treatment options continue to grow and become more complex http://jama.jamanetwork.com/article.aspx?articleid=184654

7. Medical knowledge, diagnostics, and treatment options continue to grow and become more complex

8. Medical knowledge, diagnostics, and treatment options continue to grow and become more complex http://www.ft.lk/2013/01/04/us-fda-new-drug-approvals-hit-16-year-high-in-2012/

9. Our populations are growing older and have more comorbidities Percent of Medicare Beneficiaries, with multiple conditions, 2008 -

10. Our populations are growing older and have more comorbidities http://mpkb.org/home/pathogenesis/epidemiology

11. Primary care providers alone cannot accomplish all they are expected to do Yamall, et al. 2008

12. Physician performance measures are no longer private information http://www.mslworldwide.com/dcblog/2013/04/17/reporting-on-physician-performance/

13. With all of these pressures on physicians, what’s a doc to do? : Concierge practice ratios: 200-600 patients 1 physician for http://owndoc.com/lyme/lyme-controversy-cardinal-sins-instead-of-conspiracy/attachment/greedy-doc/ http://www.pcdl-usanews.com/2014/04/30/need-more-patients-7/

14. To compound this problem, there aren’t enough primary care physicians to alone provide all recommended care http://medicinesocialjustice.blogspot.com/2011/05/primary-care-medical-school-debt-and-us.html

15. To compound this problem, there aren’t enough primary care physicians to alone provide all recommended care : Current ratio of workforce: 1 physician for 1500 patients Robert Grham Center. Available: http://www.graham-center.org/online/graham/home/tools-resources/data-tables.html . Accessed 5/9/14 Picture credit : http://www.oneaccordnonprofit.com/how-to-get-broader-based-support-for-your-mission/

16. However, that doesn’t mean that services can’t be provided with current numbers of primary care physicians Table 1. Estimated Panel Sizes Under Different Models of Physician Task Delegation to Nonphysician Team Members Altschuler, et al. Annals of Fam Med. Oct 2012.

17. However, that doesn’t mean that services can’t be provided with current numbers of primary care physicians Table 1. Estimated Panel Sizes Under Different Models of Physician Task Delegation to Nonphysician Team Members “Primary care is a team sport.” Bruce Bagley, MD, AAFP Medical Director of Quality Improvement http://medicinesocialjustice.blogspot.com/2011/05/primary-care-medical-school-debt-and-us.html

18. Patient demographics, community factors, and the care setting affect the kinds of medical teams used

19. Effective care teams include a wide variety of members

20. High-performing primary care are able to use teams for maximum benefit • Physician: Clinical leader and mentor, fewer and • longer patient visits, time for e-visits and phone visits • Other appointments available: e-visits, phone • encounters, group visits, team member visits • Preventive care and chronic disease care largely • managed by non-physician team members • Care coordination assist with continuity and • handoffs with community team members Bedenheimer et al. Annals Fam Med. Mar-Apr 2014.

21. Effective care teams include a wide variety of members, who can be arranged in several ways Boon, et al. BMC Health Services Research, 2004.

22. Providers need to undergo a shift in thinking about how care is provided in order to be able to use effective teams “I’m afraid you’ve had a paradigm shift.”

23. To effectively lead such teams, providers will need a different set of skills then the past http://www.limebridge.com.au/cartoons/team-leader

24. To effectively lead such teams, providers will need a different set of skills then the past • Roles and responsibilities • Communication • Values and ethics • Teams and teamwork Roett, Michelle. Collaborative Practice and Team Based Care. FP Essentials. AAFP. Nov 13.

25. To function well, providers and teams will need to avoid certain barriers BAD TEAM CARE

26. To function well, providers and teams will need to avoid certain barriers

27. To function well, providers and teams will need to avoid certain barriers

28. To function well, providers and teams will need to avoid certain barriers Thom, et al. Patient EducCouns, 2014.

29. To function well, providers and teams will need to avoid certain barriers

30. To function well, providers and teams will need to avoid certain barriers Team Culture and Structure on Exhaustion for Clinicians Exhaustion Mean Score Low Team Culture High Team Culture Teamlet No Team Team Willard-Grace, et al. JABFM March-April 2014.

31. In summary, the future will require physicians will need to effective employ health care teams to care for patients There are too many patients and too much recommended care to not work in teams If physicians want to be the leaders of these medical teams, they need to learn to be team leaders http://www.startribune.com/local/117835103.html Questions?

33. Increasingly, care teams will come from outside of the typical setting