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VANDERBILT MEDICINE :: WINTER 2014
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Teamwork may be key to cost control


By Carole Bartoo
August 2013

As millions of previously uninsured Americans gain access to health insurance through the Affordable Care Act (ACA), there is vigorous debate about how such an expensive program can achieve improved quality of care while reducing costs. Health Policy researcher John Graves, Ph.D., assistant professor of Preventive Medicine, says the goal of the ACA has never been to control costs, but it is a necessary first step to push toward new models of care that will.

“The goal is to reorient the system toward stability of coverage so we don’t have 50 million people at any point and time churning in and out of the system when they change or lose a job. If that stability exists, all of the organizations involved in health care have a chance of succeeding in controlling quality and cost,” Graves said.

Many physicians’ groups say the interdisciplinary Patient-Centered Medical Home model offers the best chance to turn the emphasis from acute care of ill patients to preventive care for healthier ones. Yet patient-centered medical homes are difficult to find. A Commonwealth Fund International survey found 41 percent of U.S. physician practices function without any non-physician staff to help manage the care of their patients, and only 35 percent of physicians said improved teamwork and communication are very effective ways to improve quality of care.

“We want to get better value for what we put in. We want to pay for the right things and not the wrong things,” said Graves. “As a result, there is a tremendous amount of effort on the provider side to try to prove value of these new models through demonstration projects.”

United Neighborhood Health Services (UNHS), one of the largest providers of primary care to uninsured and TennCare patients in Nashville, recently received Joint Commission status as a Patient-Centered Medical Home. UNHS CEO, Mary Bufwack, Ph.D., said the population they serve is unaccustomed to preventive care. She hopes demonstration projects will show patients benefit from services like social work and case management to foster engagement.

One encouraging sign that change is on its way, she says, is the number of new physicians coming out of programs like Vanderbilt’s who already expect to be part of an interdisciplinary team.

“It’s patient-centered and not provider-centered and new physicians trained in this model understand and value this,” Bufwack said.

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