ACP issues policies to strengthen, expand team-based care models

Key takeaways:

• According to the ACP, team-based care models improve patient outcomes.
• The organization reaffirmed the importance of physician leadership in team-based care.

The ACP released recommendations in four key areas —professionalism, licensure, payment delivery and research — to support the expansion and effectiveness of team-based care.

“Wider use of physician-led health care teams would be extremely beneficial for patients, physicians, and the rest of the health care team,” Omar T. Atiq, MD, MACP, president of the ACP, said in a press release.

The recommendations, developed by the ACP Health and Public Policy Committee and published in Annals of Internal Medicine, are an update to the organization’s 2013 policies on team-based care.

The policies aim to address barriers that may impede successful outcomes from these care teams, which according to Ryan Crowley, BSJ, a senior associate of health policy at ACP, and colleagues, can include high implementation costs, suboptimal financial incentives and scope-of-practice changes.

Professionalism

Crowley and colleagues noted that physicians should ultimately have primary leadership responsibilities in a team-based care model, and they are not interchangeable with other health care professionals “as they have substantially different training and competencies.”

“Efforts to allow nonphysician health care professionals such as [nurse practitioners] and [physician assistants] to practice independently may sever the patient-physician relationship, undermine team-based collaboration, increase the risk for poor health outcomes, and drive up health care costs,” the authors wrote.

The policies also emphasize that clinical and coordination responsibilities within the care team should be based on the patient’s best interests, and patients should be aware of each member’s qualifications and responsibilities.

Licensure

The authors noted that the purpose of licensure must be to ensure public health and safety, and that licensing bodies should recognize that the skills, training and clinical experience of physicians, nurses and physician assistants with other health care professionals are not interchangeable.

“State legislatures should conduct an evidence-based review of their licensure laws to ensure that they are consistent with these principles,” they wrote.

Payment

The ACP affirmed that health care delivery and payment models, like the Patient-Centered Medical Homes and Patient-Centered Medical Home Neighbor practices, be redesigned in order to support team-based care.

These models should also be structured in a way that ensures access to care while helping those experiencing health care inequities and disparities related to social determinants of health and personal characteristics.

Research

The ACP lastly called for continued research on ideal formulation, functioning and coordination of team-based care. Further areas that could be explored include how team-based care helps reduce physician burnout and communication strategies that help patients and their families understand the roles of each team member’s area.

Editorial

In a related editorial, Rebecca S. Brienza, MD, MPH, an associate professor of medicine at Yale School of Medicine, emphasized team-based care models should be transparent, flexible, dynamic “and should include physicians and nonphysician health professionals to be best able to benefit from all members' expertise and experience.”

“Most importantly, the team leader should be able to facilitate utilization of all team members’ expertise to contribute collaboratively to provide the best patient care,” she concluded.

References:

• ACP underscores the importance of physician-led team-based care in new policy. https://www.acponline.org/acp-newsroom/acp-underscores-the-importance-of-physician-led-team-based-care-in-new-policy. Published Dec. 25, 2023. Accessed Jan. 4, 2024.
• Brienza R, et al. Ann Intern Med. 2023;doi:10.7326/M23-3153.
• Crowley R, et al. Ann Intern Med. 2023;doi:10.7326/M23-2260.