The Case for Interprofessional Collaboration SYNC Program Alan Dow, MD, MSHA Virginia Commonwealth University
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The Crisis Moment Silver tsunami Existing cost problem Existing equity problem
The Way Forward: Population Health
Current model of Care Fee for service, value-based payment Ancillary team (OT, PT, Speech, nutrition, etc) Patient/ clinical site Core team (RN, MD, clerical) Support team (admin, facilities)
Fee-for-service Value-based payment Provider Patient Provider Patient + Outcomes
New model of Care Pay for outcomes Ancillary team Population/ community Core team Support team
Fee-for-service Value-based payment Population-based payment Provider Patient Provider Patient + Outcomes
Hospitals and Insurer Join Forces in California - New York Times, Sept. 17, 2014 Anthem has created a integrated delivery network with seven hospital systems which all have hospitals ranked in the top 30 in the Los Angeles and Orange County areas by U.S. News & World Report* are Cedars-Sinai, Good Samaritan Hospital, Huntington Memorial Hospital, MemorialCare Health System, PIH Health, Torrance Memorial Medical Center and UCLA Health. Competitor to Kaiser Permanente Cost to purchaser will be 10% less than other plans Signed up CalPERS
Kaiser Permanente Anthem/BCBS
Virginia Insurance Exchanges
Date Partners Value June, 2015 July, 2015 Rite Aid & Envision Rx United Health Group & Catamaran 2 billion 12.8 billion Pending Anthem + Cigna 54.2 billion
MACRA (SGR Fix) Transition to merit-based or alternative payment models 2019 MIPS (Quality + meaningful use + resource use + practice improvement) -4% to 12% payment adjustment Alternative payment model Advanced PCMHs 5% bonus 5% bonus
Drivers of Interprofessional Collaboration Silver tsunami Existing cost problem Existing equity problem Payment approach Policy approach
Insights about Interprofessional Collaboration
Collaboration in the ICU Researchers looked at three ICUs Assessed collaboration independently and as scored by providers Correlated with clinical outcomes Baggs et al. Critical Care Medicine. 1999.
Collaboration in the ICU when the nurse reported no collaboration in transfer decisionmaking, the risk of a negative outcome was 13.9%; when the nurse reported complete collaboration, the risk was 3%. Resident or attending ratings of collaboration had no association with patient outcomes. Independent unit-level collaboration scores across three units also positively correlated with patient outcomes. Baggs et al. Critical Care Medicine. 1999.
Collaboration versus non-collaboration for depression in primary care 276 individuals received collaborative care 305 individuals received usual care Collaborative care group had: Better depression scores Higher patient satisfaction Richards et al. BMJ. 2013.
Using Space to Drive Collaboration General medicine physicians assigned to a single nursing unit Better physician and nursing scores about collaboration and safety Better patient scores on knowledge of illness, physician satisfaction Olson et al. J Healthc Qual. 2015.
Interprofessional Collaboration: Are We All on the Same Page? Utilitarian Evidence Validity Emancipatory Power Dominance Haddara & Lingard. Acad Med. 2013.
Interprofessional Collaboration: Are We All on the Same Page? An analysis of rounds: In all instances, caregivers had formed working groups rather than working teams. Participants consistently exhibited parallel interdependence...rather than reciprocal interdependence..., the hallmark of effective teams. With one exception, the organization was hierarchical, with the senior attending physician possessing the authority. The interns exclusively communicated with the attending physician in one-on-one conversations that excluded all other members of the team. Although nurses and pharmacists were often present, they never contributed their ideas and rarely spoke. Bharwani. Acad Med. 2012.
The Current Landscape of Interprofessional Collaboration Significant Drivers: Silver tsunami Existing cost problem Existing equity problem Policy approach Payment approach Equity Evidence of impact, depending on context Blind spots to our challenges A need to define best practices
Questions and Discussions alan.dow@vcuhealth.org