How Will This Toolkit Help Me?
Learning Objectives
Explain the essentials of a team-based care approach to care delivery
Describe telemedicine acceleration, advantages, and opportunities
Identify how to implement team-based care in telemedicine
In the spring of 2020, the COVID-19 pandemic accelerated the adoption of telemedicine (virtual visits) among patients, health care professionals, and health systems.1 In this toolkit, we share new team-based care models for telemedicine based on recent institutional successes in the era of COVID-19. While many health systems plan to continue using telemedicine beyond COVID-19, the focus of this toolkit is how to optimize telemedicine in the context of the current public health emergency.
Physician-led team-based care (TBC) is a cornerstone of practice sustainability, and great strides have been made in developing and implementing team-based care models to support traditional in-office medical practices over the past decade.2- 6 However, our experience with care delivered via telemedicine platforms has been limited until now and has generally not undergone the same team-based care innovations. The “doctor-does-it-all” model is no more sustainable in a telemedicine environment than it is in a traditional in-office practice model. While advantageous, a pre-existing in-office team-based care practice model is not necessary for the successful incorporation of team-based care into telemedicine.
A team-based care model (Figure 1) is a higher-efficiency practice model, designed to:
Increase accessibility
Improve quality of patient care
Increase patient access to care
Improve care team efficiency
Improve satisfaction and engagement for patients and health care professionals alike
Though this model has been shown to decrease clinician burnout and improve professional satisfaction in a financially sustainable way, the ultimate goal is to improve the health of the patient population. Enhanced team engagement with patients, improved quality measures, and the clinician's greater ability to give their full attention to the patient during the interaction are powerful reasons to implement team-based care.
Five STEPS to Implement Team-Based Care in Telemedicine
Define and Engage the Team
Choose a Model
Develop Team-Based Care Workflows
Implement Workflows
Iterate and Optimize the Model
STEP 1 Define and Engage the Team
Identify the people who are key to team success. Start with those team members you work most closely with every day. What do they do now to contribute to patient care? Who do you think you need on the team and why? Engage them in dialogue about the need for change. Have individual conversations to share your vision until your vision becomes shared. Bring people together to discuss the opportunity to build a better way to care for patients. Value the perspective and experience of each person. Empower individuals in order to empower the team.
In addition to the physician, consider including:
Quiz Ref IDThere are 2 general models for team-based care for telemedicine: synchronous support and asynchronous support (Figure 2).
Quiz Ref IDFor both synchronous and asynchronous models, physical co-location of the physician and medical assistant (eg, together in the office as opposed to working from home) has definite advantages, but may not always be practical. While asynchronous telemedicine visits can be streamlined with either physical co-location or separate locations (work from home), synchronous telemedicine visits are challenging without co-location with the current state of technology. Some virtual visit platforms include an option to invite an additional virtual participant other than the clinician and the patient, and the use of these technologies is evolving rapidly.
Each model has pros and cons, and it is important to discuss both options as a team. Which makes the most sense for your team? Consider which model your current staffing may best be able to support. Discuss how you might adapt one of the models to your specific practice situation. Commit together to give it a try, and learn from your collective experience, recognizing that you/your team can always make changes. It will also be important to confirm that the model will be recognized and accepted by all of your practice's payers.
Telemedicine team-based care models vary from practice to practice and are dependent on the practice's staffing model as well as individual state laws and regulations. Table 1 shares example synchronous and asynchronous models that you may find work for your practice.
STEP 3 Develop Team-Based Care Workflows
After a model is chosen, more detailed workflows can be developed. Look to existing standard work as a starting point. Adapt existing workflows for the telemedicine platform, or co-create new ones. Aim to mirror patient and caregiver experience with that of in-office encounters.
The process of developing a workflow should include:
Creating a workflow diagram with specific tasks and responsibilities associated with each step in the patient journey
Bringing the team together to discuss which role is most appropriate for each duty
Clearly defining and assigning the roles and responsibilities of each team member
Example Workflows: Team-Based Care Virtual Visits (48 KB)Two practices share their approaches to successful virtual visits. While Bellin Health uses a synchronous approach, Cleveland Clinic uses an asynchronous approach.
As you develop the ideal workflow for your practice, consider incorporating an assessment of the conditions that may be most appropriate for in-person or virtual visits.
In-Person or Virtual Visit? (46 KB)A guide with considerations to help you and your team determine whether an in-person or virtual visit is warranted.
STEP 4 Implement Workflows
Set a specific and realistic timeline for implementation. It does not have to be all or nothing: you can start simple by making one straightforward, yet impactful change in workflow. Be flexible with the planned schedule, but make progress.
It may be helpful to start with a small pilot of teams that are early adopters. This helps work out challenges with the workflows, and can usually be done with existing support team members, minimizing expense. From there, workflows and processes can be refined and scope expanded.
STEP 5 Iterate and Optimize the Model
Come together for regular team meetings. Be open and honest; freely discuss what works well and what needs work. Keep each other accountable and willingly submit yourself to feedback, both process-related, and personal. Be patient and show grace to one another as you navigate this change. When things aren't going as well as they might, try something different. Be flexible. Mix it up, and remember to write it down—both what you did and how it went—so you know for next time. Don't forget to use patient feedback at every opportunity. Finally, celebrate your wins together as a team.
As you iterate and optimize your model, here are some telemedicine “Practice Pearls” that we have found useful from our experiences thus far (Figure 3):
The adoption of telemedicine was accelerated as an effect of the COVID-19 pandemic, and yet its optimal utility in patient care has yet to be fully established. Early experience suggests that telemedicine implemented without attention to workflow risks minimizing team-based care and introduces new barriers to efficient care. It is important to adapt and build upon our experience with in-office team-based care as we develop new models of team-based care to support telemedicine after the public health emergency (and waivers and exclusions limited to the public health emergency) is over. Telemedicine will likely prove to be a very valuable tool, and gives us another means to stay connected to our patients, with or without a pandemic.
Journal Articles and Other Publications