Using Empowered CMAs and Nursing Staff to Improve Team-based Care

 

Highly trained workers can perform more visit-related tasks, boosting care quality and reducing physician burnout.

Fam Pract Manag. 2019 Jan-Feb;26(1):17-22.

Author disclosure: no relevant financial affiliations disclosed.

Team-based care has become popular as the health care industry looks for new approaches to both deliver patient care and reimburse physicians.1 Many models are available, but we developed our own version of advanced team-based care built around the idea of providing physicians with substantial support, which we believe not only improves the care of our patients but also helps alleviate health care worker burnout.

Bellin Health is a community-based health care system serving northeastern Wisconsin and the upper peninsula of Michigan. We currently employ about 130 primary care physicians and advanced practice clinicians in our 30 clinics across the area. The system also includes two hospitals and a growing base of specialists.

Our model of team-based care has three main elements:

  • Total redesign of the office visit, including a greatly enhanced role for empowered certified medical assistants (CMAs) and licensed practical nurses (LPNs) who now close care gaps, review patient medication, and provide a key role working with the electronic health record (EHR) during visits.

  • A team approach to completing “in-basket” work performed between visits, including patient forms, lab results, medication refills, prior authorization requests, and other paperwork that usually falls to the physician. We do this by leveraging daily huddles and co-location — having team members work in close quarters to make communication more efficient. This element features an enhanced role for care team registered nurses (RNs), who provide both administrative services and direct patient care.

  • Development of an extended care team, including case managers, clinical pharmacists, diabetes educators, RN care coordinators, and others who support the care of our complex and high-risk patients.

This article will focus on the enhanced roles for the CMAs, LPNs, and RNs in our model and describe some of the ways we help these valuable team members become comfortable and efficient in their new roles.

KEY POINTS

  • Advanced team-based care uses well-trained certified medical assistants, licensed practical nurses, and registered nurses to take over more facets of the patient visit, freeing up time for the physician.

  • Care team coordinators run the daily morning huddle, do pre-visit planning, find and resolve patient care gaps, and handle electronic health record duties during the patient visit.

  • Registered nurses oversee blood pressure follow-ups, annual wellness visits, chronic care management services, and transitional care management services.

  • Even small practices can use advanced team-based care if they proceed slowly, find which parts work for them, and make sure new personnel generate sufficient revenue to make the model financially sustainable.

ABOUT THE AUTHOR

Dr. Jerzak is a family physician with Bellin Health in Green Bay, Wis., and is the physician lead for Bellin's transformation to advanced team-based care.

Author disclosure: no relevant financial affiliations disclosed.

References

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3. Carney PA, Waller E, Dexter E, et al. . Team training in family medicine residency programs and its impact on team-based practices post-graduation. Fam Med. 2017;49(5):346–352.

4. Bodenheimer T, Bauer L, Syer S, Olayiwola JN. RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care. Oakland: California HealthCare Foundation; 2015. https://www.chcf.org/publication/rn-role-reimagined-how-empowering-registered-nurses-can-improve-primary-care. Accessed Oct. 29, 2018.

5. Chung S, Lesser LI, Lauderdale DS, Johns NE, Palaniappan LP, Luft HS. Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate. Health Aff (Millwood). 2015;34(1):11–20 [published errata appear in Health Aff (Millwood). 2015;34(2):359]

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7. Eden RS. Maximizing your medical assistant's role. Fam Pract Manag. 2016;23(3):5–7.

8. Jerzak J, Sinsky C. EHR in-basket restructuring for improved efficiency. American Medical Association: STEPS Forward. 2017. https://www.stepsforward.org/modules/ehr-inbasket-management. Accessed Oct. 30, 2018.

9. Bodenheimer T, Sinsky C. From triple aim to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.

 
 

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