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    Here's how physicians can build the best care team

    Care teams exist in nearly every medical office. But relatively few practices have organized and enhanced their care teams to increase efficiency and the likelihood that every patient will receive recommended care, says internist Charles Kilo, MD, who formerly led the Institute for Healthcare Improvement’s practice improvement initiative.

    The biggest reason, Kilo says, is that value-based reimbursement has not fully taken hold, and a fee-for-service practice doesn’t need this kind of care team to succeed financially. But he and other experts maintain that, even under fee-for-service, care teams can improve practice efficiency, increase patient access and produce better outcomes. 


    How care teams work

    Generally anchored by a physician, a care team includes registered nurses (RNs) and/or licensed practical nurses (LPNs), medical assistants (MAs) and front-office staff, such as receptionists and schedulers. 

    Some practices, mainly larger groups, have expanded their care teams to include behavioral health specialists, nutritionists, physical therapists and social workers. 

    RNs most often function as care managers for chronically ill patients. But care managers don’t have to be RNs, who are an expensive resource for small and medium-sized practices. Greenfield Health in Portland, Oregon, an 11-provider group where Kilo practices part-time (he’s also a consultant), has decided not to hire RNs because it can’t afford them, he says. Instead, the group has trained their MAs to do most of what RNs can do in ambulatory care.

    A key characteristic of a care team is that its members are expected to work at the top of their licenses. In most cases this requires additional on-the-job training, but experts say working this way is good for staff morale. 

    “From the perspective of job satisfaction, the retention rate for advanced practice clinicians and other clinicians is a lot higher in an environment where they’re doing what they were trained to do, rather than just manage in-basket work all day,” says Krista Fakoory, MBA, senior manager with ECG Management Consultants in San Diego.

    Another important feature of care teams is that members share responsibility for patient care. The physician still has the ultimate responsibility, but he or she delegates part of the care and the logistics that support it to other team members. This may include pre-visit care, such as medication reconciliation, chart reviews and lab result checks. During visits, it may include patient education, vaccinations and even prescription refills following clinical protocols.


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