简而言之: 在我们正在进行的基于价值的护理(VBC)系列的第三部分中, we explore how physician enterprises can operationalize their VBC plans through an effective staffing infrastructure.
在它的核心, 医疗保健就是人们照顾别人, with providers and support staff being the lifeblood of any medical practice. Healthcare workers are called to their profession by a desire to serve others.
VBC provides a pathway to that vision by aligning payments with how successfully those people take care of other people. By reconfiguring the support staff infrastructure within a provider organization and thinking creatively about the accountable physician enterprise’s patient population and its needs, a team-based care model emerges—one that works collaboratively with patients and caregivers to achieve high-quality outcomes. Designing and operationalizing that model is key to organizational success in the transition to value.
调整你的VBC目标与你的病人和实践
The first principle of the transition to VBC is to understand your patient panel and its demographics, 以及你的实践基于价值的目标, 然后 相应调整支持人员.
人力资源有限, and each new role must be carefully assessed to ensure it is right for the organization. A few key questions will inform the planning for a value-based staffing infrastructure:
1. How would you describe your current and planned future patient population, and does this population have any predominant characteristics you plan to address through VBC?
- A primarily senior population with accompanying social and/or medical concerns
- A population that is medically complex with risk for high-cost medical events like admissions, 再次入院, 和/或ED的利用
- A population with high rates of substance use and behavioral health concerns
- 社会需求高和/或经济有限的患者
- 病人和需求的混合, where the practice is focused on providing different types of care to a broad population
2. 你们目前的付费用户状况和策略是什么, 在未来的三到五年内预计会发生怎样的变化? What do you expect to experience or prioritize in your upcoming payer contracts?
- A transition to financial and population health, with greater emphasis on utilization (e.g.(每1,000人就诊次数)或健康保养活动(例如.g.,癌症筛检率)
- 越来越多的病人加入了医疗保险优惠计划, 管理医疗补助, 以及以价值为中心的商业计划
- 坚持以证据为基础的护理关键临床条件(如.g.糖尿病、心力衰竭)
- 对实践之外的结果和护理负责.g.(全因再入院率,SNF)
3. Where are the areas of opportunity within your clinical operations that will enable you to achieve VBC delivery?
- Patient access, including an adequate number of urgent, same-day, or next-day visits
- Patient adherence to clinical screening recommendations and follow-through on referrals, which can include connecting patients to social work and behavioral health services
- Overall operational throughput, wait times, and care navigation capabilities
建立合适的人员配置基础设施
To support the VBC transformation, new skill sets, and support staff members will be needed. The titles will vary from organization to organization, but generally these functions include:
- 复杂护理管理:取决于患者群体和VBC的重点, 综合护理管理人员通常是社会工作者或护士. 他们的作用是帮助管理高危患者和, 重要的是, 病人在门诊环境中变得复杂的风险, 以尽量减少可避免的急诊科或住院时间.
- 面板的导航: With a focus on screening rates and adherence to evidence-based protocols, 管理病人小组显得更为重要. 面板导航器, 小组经理, 或者外联协调员, who may be a trained layperson or a medical assistant if a clinical credential is preferred, 进行接触和外展. 与外展活动一样,接触活动可能侧重于特定的活动(如.g.(流感疫苗)、一般健康保养(例如.g., 应做结肠镜检查的病人。, 或达到诊所或bet8网站备用的筛查阈值(例如.g., a physician needs two more mammograms for their population to meet their quality goal).
- 流动的药店:临床, 非固定的, or population health pharmacist participates in the care of complex and rising-risk patients. The pharmacist will play a key role and focus on medication management for their assigned population, 包括处方依从性, 药物审查和患者教育, 确定具有成本效益的替代方案, 访问之间的管理. 在传统模型中, 提供者有时可以咨询药剂师, while in VBC the pharmacist is fully integrated as a member of the care team.
- 行为健康与社会工作这可能是一个有执照的治疗师, 药物使用顾问, 社会工作者, 或相关角色, 这取决于诊所病人的社会需求. 在一些组织中, 可能有重大的社会和行为健康需求, 这个团队可能包括不止一个护理人员. 通常, these team members will be supported by psychiatrists or psychologists to whom more complex patients can be referred or from whom an electronic consult can be obtained.
来源: 用药管理|完善基层医疗团队指南
The final consideration related to staffing is how and where the support staff will do their work. While remote work and centralization are popular among staff and employers both, 必须有一个平衡来确保团队的活力得到维持. 随着护理团队的壮大, cohesion and role clarity are essential to ensure each team member knows and fulfills their role and all tasks are completed. Using standardized workflows will allow all care team members to understand their role within the context of the clinic as a whole. 以团队为基础的护理 is a new concept for many practices and requires flexibility and understanding to implement.
VBC的人员重新设计
A transformation to value enables providers to care for patients holistically, helping to address not just their medical conditions but their social and personal needs as well. This requires a strategic overhaul of existing staffing infrastructure—your organization will have new work to complete, 需要新的技能. Conduct a detailed review of existing support staff and skills to identify competencies that can be developed from within and new roles that need to be created, 比如护理协调, 筛选, 以及基于价值的文档技能. An effective staff infrastructure designed for VBC will position an organization to achieve success under value-based contract arrangements, 这些是否属于共同储蓄, 质量奖金, 或者按人头安排.
接下来是什么?
在我们基于价值的护理系列的最后一篇文章中, 我们将探讨优化资讯科技的重要性, 电子健康档案, 以及基于价值的护理的分析工具.
联系 us for expert guidance in navigating your organization's value-based care staffing model.
编辑:马特·马斯林
出版于2024年1月22日