The circle of care is wide – and getting wider. With all the national conversation around diversity and inclusion, I think the healthcare field can give itself a pat on the back, at least on the inclusion side. But I refer to a different kind of inclusion here – and that’s the inclusion of a broad spectrum of caregivers as an extension of the care team – and ultimately into the world of reimbursement.
For too long, the focus was chiefly on the physician when it came to care and reimbursement, but the value of the care team has grown too strong (based on supporting data and anecdotal evidence) to look back. With patient outcomes improving as the availability of care teams increases, especially interdisciplinary teams comprised of nurses, dieticians, behavioral health specialists, exercise specialists, pharmacists and care managers, the care experience continues to evolve in a positive direction.
In 2006, our organization assembled one of the state’s first care team efforts. We called it the Chronic Care Travel Team (CCTT) and launched the program with the aim of focusing on patients with co-morbidities including diabetes, hypertension and obesity, as part of their care team in the primary care physician’s office. The name ultimately morphed into Community Care Travel Team to better reflect not only our patient population but the need to get out into the community to offer team-based primary care. The CCTT continues to be a core part of our services today.
While we may have thought we were healthcare delivery innovators at the time, it’s humbling to admit I’m quite certain we never even considered extending the care team beyond those specialty areas. But then along comes the earnest efforts of BCBSM and others backing the patient-centered medical home and the PCMH-Neighborhood and boom, all of a sudden, we are pushing past previous real or perceived boundaries to get where we are today.
I’ve taken the long route to addressing the next level of inclusion, but here it is: first responders. Emergency Medical Technicians (EMTs) are instrumental in critical care situations that occur outside of the hospital or doctor’s office setting. It’s not just life or death situations, however. With the epidemic of loneliness in our country and the isolation of too many of our seniors, EMTs are often called to non-emergency situations. Instead, they are calming the fearful or lonely who, while they may have medical or behavioral health conditions, the current call is actually for human comfort and companionship.
Historically, ambulance services are only paid when they take a patient to the hospital. Now, through a BCBSM pilot program for reimbursement, their role is recognized as a part of the care team, with EMTs able to call the primary care physician from the scene to assess the situation together and decide if a hospital trip is immediately required, a doctor’s office visit should be scheduled, or if one or more community service agencies should be called in for a non-clinical, yet vital, assessment. In the evolution of healthcare teams, this pilot program allows for both EMT and PCP services to be reimbursed. It’s too soon for meaningful outcomes data to be available, but this strikes me as a program that will reduce emergency department visits and costs. Let’s continue to think inclusively of care teams as we focus first on what’s best for patients.