Shift in Healthcare
Steve Jobs once said, “The people who are crazy enough to think they can change the world are the ones who do.” (1) Speaking of Steve Jobs and changing the world, do you remember when Apple rolled out the first iPhone in June of 2007? Just a few years prior to that, Google went public in 2004, launching its mapping service a year later in 2005. In addition, Facebook came on the scene in 2004, with the birth of YouTube right behind it. (2) That’s just scratching the surface of all the major technological advancements birthed in the early twenty-first century that changed daily life forever. Imagine what the not-so-distant-future generations will say about the evolution of the world of medicine just within the last year and a half! No doubt about it, the world of medicine is evolving at warp speed and one of those major changes is the shift from fee-for-service healthcare to value-based healthcare.
Value-Based Care = Team-Based Care
On the topic, Kathy Gibala writes in her MEDI Leadership newsletter, “Over the past several years a lot has been written and done around team-based care. A few of the reasons for this increased focus include: the changing healthcare industry landscape; the shift to value-based care; Quadruple Aim goals (raising population health, improving patient experience, reducing waste/cost, and enhancing care team well-being); the rise of the empowered consumer along with increased expectations regarding access, efficiency and high reliability; provider burnout; and the looming physician shortage.” (3)
For all of these reasons, long gone are the days in which patients see a single physician for each and every one of their healthcare needs. The shift to value-based healthcare requires a team of professionals, collaboratively working together to achieve optimal and cost-efficient health outcomes for patients. The role of the APP (advanced practice provider) (specifically the nurse practitioner for today’s Thinking Thursday TIPs) is proving to be a valuable asset on a healthcare team. Take a look at this passage found in The National Advisory Council on Nurse Education and Practice’s report: “To shift from volume to value-based care, the delivery of health care services will need to be redesigned to support team-based care, nurses will need to be able to practice to the full scope of their education and training, and nurses at all levels will need to be able to fully utilize electronic data and health information and communication technologies.” (4)
Nurse Practitioners on the Rise
Health Leaders reports, “The number of nurse practitioners (NPs) in the U.S. has grown substantially over the 10 years, according to survey results recently released by the American Association of Nurse Practitioners (AANP). According to the survey, there are an estimated 270,000 licensed and practicing NPs in the U.S., which is slightly higher than the AANP’s projected 248,000 NPs from March 2018. This number is twice the number of practicing NPs in 2007 (120,000).” (5) Furthermore, author Michelle Clarke quotes AANP President Joyce Knestrick, PhD, APRN, CFNP, FAANP: “NPs are the providers of choice for millions of patients… Current provider shortages, especially in primary care, are a growing concern, yet the growth of the NP role is addressing that concern head-on. The faith patients have in NP-provided health care is evidenced by the estimated 1.06 billion patient visits made to NPs in 2018.” (5) Both healthcare facilities and patients are starting to discover the value nurse practitioners bring to the healthcare team table.
Increasing Demands for Healthcare
The growth of nurse practitioners has been dramatically amplified during the last year and a half. Medical Group Management Association (MGMA) reports, “Increasing demands for healthcare point to a projected physician shortage, estimated to reach between 54,100 and 139,000 physicians by 2033. One strategy to address this shortage is to close gaps in primary care access through increased use of APPs. One estimate points to expanded use of nurse practitioners (NPs) could reduce primary care physician (PCP) shortages by 70%. Many practices already recognize the substantial boost that APPs can provide to practice performance, with APP utilization growing. MGMA data show that almost 67% of Better Performer practices employ APPs; for physician-owned practices, that rate jumps to almost 87%.” (6) Expanding the use of nurse practitioners is gaining momentum as providers, healthcare facilities, and patients are all becoming aware of the value they bring to the table.
Jointly Customizing Care
Let’s take a deeper look at the previously mentioned MEDI Leadership article, “Team-Based Care: It’s a Worthwhile Journey,” in which author Kathy Gibala defines team-based care: “Team-based care benefits all involved—patients, families and care team members as well. In team-based care, physicians, nurse practitioners, physician assistants, nurses, medical assistants, dietitians, social workers and others function as an integrated team, jointly customizing care to a patient’s individual needs.” (3) Furthermore, she captures this statement from Dr. Brent Wallace: “From the patient’s perspective, medicine has always been team-based care. It has never been the patient interacting solely with a physician. Coordination is what has been lacking… To provide cost-efficient, effective care in today’s environment, we need to utilize all members of the team to provide care. Primary care physicians often do things we don’t need physicians to do. We can provide higher quality, cost-effective, better care through a team approach.” (3) It’s not about one key player – the physician or the nurse practitioner. It’s about all of the team members coming together to achieve optimal health and cost-efficient outcomes.
Gibala captures several testimonies of healthcare professionals currently working as part of a healthcare team to deliver value-based healthcare to patients:
Debra Harrison, RN, states, “I believe it increases a patient’s trust and confidence to see care team members working together. More minds are better than one. We come at it from different perspectives and working together helps us to think synergistically.” (3)
Mitchell Stucky, MD, a family practice physician with Parkview Physicians Group in Ft. Wayne, Indiana says of his seven years of experience with the team-based healthcare model, “Patients see that we truly work together. These are OUR patients; we are one team, one mind.”
Shannon Tranquill, a nurse practitioner in Dr. Stucky’s office adds, “We lean on and help each other. We support each other around our patients’ goals and care plans. It is much less fragmented than in the past. We learn from each other, share our knowledge and experience, respond promptly to each other when there are questions or concerns, and work in the best interests of our patients. I really appreciate a physician partner who wants me to learn and contribute positively to the practice. Team-based care also helps with provider burnout and promotes high levels of work satisfaction.” (3)
John Anderson, MD, MEDI Leadership colleague, and former chief medical officer with Baylor University Health and CHI states, “Our traditional physician training reinforced working independently and that all decisions needed to go through us. Everyone wins when we shift to a more efficient, effective team-based approach.” (3)
More and more, healthcare professionals and patients all across the board are benefiting from team-based care.
I Encourage You
The shift from fee-for-service healthcare to value-based healthcare means treating patients holistically, with the collaboration of various different healthcare professionals working together under the common goal of optimal health and cost-efficient outcomes for patients. It’s a major advancement in the world of medicine and will no doubt lead to improved patient experience. Nurse practitioners are a key component of value-based healthcare. Perhaps in a couple of decades, we will look back and wonder how we ever operated under a fee-for-service model of healthcare. I’ll leave you with a bit of encouragement through the words of Nurse Practitioner Lisa Foldesi, “Come to it with an open mind about what APPs can bring to the practice. They aren’t looking to take patients from physicians. They are looking to partner to help the patients and provide great care as part of a team.” (3)
Please let us know if you have comments or questions, and subscribe to our Email Updates so that you can be assured to receive Thinking Thursdays TIPs.
Jerry L. Stone
default/files/hrsa/advisory- committees/nursing/reports/ 2019-fifteenthreport.pdf
healthleadersmedia.com/ nursing/number-nurse- practitioners-rise
resources/landing-pages/ optimizing-advanced-practice- providers-in-healthca