Will Teamwork Deliver on the Promise of Value-Based Care?

“If you want to go fast, go alone. If you want to go far, go together.”

The pandemic accelerated a number of healthcare trends, including value-based care, a model that rewards more care coordination and better patient health outcomes.

But there's a long way to go before we can say that the fee-for-service model is in the rear-view mirror, and we've truly overcome the barriers to interoperability and seamless information sharing. Over a quarter (27.5%) of primary care providers say they still don't receive hospital discharge summaries for follow-up appointments. This lack of care coordination costs the United States an estimated $148-$226 billion annually.

Earlier this year, I spoke with Dr. David Nash, the Founding Dean Emeritus at Jefferson College of Population Health, about how teamwork can catalyze and optimize the shift to value-based care. Internationally recognized for his work in public accountability, outcomes, physician leadership development and quality of prior improvement, Dr. Nash made a compelling case about why teamwork can help improve outcomes and reduce costs.

“Real teamwork means you've got to be able to safely go against the authority gradient without recrimination.”

Dr. David Nash

Jefferson College of Population Health

• Q: Skelton: How has teamwork evolved in healthcare?

  A:

  Dr. Nash: Three decades ago, the whole idea of a pharmacist calling a doctor to say, "Hey, have you thought about this renal dosing," was out of the question, right? But today, we accept this collaboration as a part of delivering good care. Our pharmacy team delivers thousands of phone calls per month to prescribing doctors, including over a thousand house officers across our institution.

  Clearly, teamwork has got to be the watchword for the future. And healthcare is a team sport. We all know that, but have we really trained to be a team? Have we practiced teamwork? Have we embraced crew resource management, like the airline industry and aviation in general?

  We understand that good communication improves clinical outcomes, and we can certainly improve our teamwork. And real teamwork means you've got to be able to go against the authority gradient without recrimination safely.

  Learn more about Dr. Nash’s perspective of how data helps foster teamwork and collaboration.

  Q: Skelton: How do pharmacists fit into the greater care team?

  A:

  Dr. Nash: I wish I had a pharmacist with me all the time in the office and at the bedside. With all the new drugs and therapies on the market and in the pipeline—it's complicated. How could any one primary care doctor keep up? And the answer is they can't, so let's get real and appreciate pharmacists. It's all about teamwork and accepting feedback from folks who may know a heck of a lot more than we do about which drug the patient needs. I mean, if you look at the various classes out there right now, it makes your head spin.

  I think we're in a unique moment in medical history because of the pandemic and the pharmacist's role is now front and center. They're getting their due, public adulation, and considered a trusted voice in the community. I think it's an amazing opportunity, and it's a unique inflection point in time to say, "Hey, they are a part of the team and need to be listened to on a regular basis. Not just an exception when there's some complex issue, but day in and day out." I think we've got to take advantage of this unique opportunity.

  Q: Skelton: What's needed to align diverse groups to drive performance and quality improvements across health care?

  A:

  Dr. Nash: That's a fantastic question. And honestly, I've been working on this for three decades. We know there are basic tenets needed to be operational – among them are transparency and accountability. And I think the next step is non-punitive feedback about your performance.

  For example, "Hey, Dr. Nash, it's pretty clear that your generic prescribing rate is only one-half of everybody else in your group or based on a local or national norm. What's up with that?" I think using data to close the feedback loop in a non-punitive way is what doctors, nurse practitioners or pharmacists want.

  And finally, let's not forget about asking patients, "How's this going for you? And are you taking your meds? And what are the side effects? And could we have provided you with better information so that you'd maintain adherence and compliance?"

  Find out how Dr. Nash thinks Surescripts is helping health providers get to the next level of care.

  Q: Skelton: With all of this digitization and collaboration, what does the future of healthcare look like?

  A:

  Dr. Nash: I hope – I think – we're headed to a world of "value-based payments." When we opened the doors to our College of Population Health back in 2009, nobody wanted to talk about "no outcome, no income." Maybe we could amend it and say, "better outcomes get better reimbursement."