Healthcare delivery reform: Bigger isn't always better

The healthcare industry is pulling out all the stops to improve care delivery, but many organizations find it easier said than done. One reason is healthcare leaders overlook the benefits of small, low-risk clinician teams, argues a blog post from Harvard Business Review.

The model of small, full-time clinical teams has already proven successful in care innovation and delivery for specific patient populations, writes Chris Trimble of the Dartmouth Institute for Health Policy and Clinical Practice. The post cites the 1998 case of Duluth, Minnesota's Essentia Health, which established such a team to deal with discharged congestive heart failure (CHF) patients. The initial team the hospital convened comprised only a nurse practitioner and a medical assistant, with an on-call cardiologist and a part-time medical director for support.

CHF patients are at high risk for readmission, since many of them leave the hospital with limited understanding of how to manage their condition. That's where the Essentia team, which has since expanded to seven nurses and seven nurse practitioners, comes in, according to the post. The team monitors 2,500 CHF patients, starting with a meeting within a week of discharge wherein the team takes stock of patients' lifestyles, explains their medication regimen and makes sure patients know to call in case of any change in their symptoms.

Despite Essentia's success, providers have been slow to adopt such models because under traditional fee-for-service reimbursement systems, hospitals generally take a loss on them, Trimble says. With the advent of payment reform and a push by the federal government toward adoption of value-based systems, now is the perfect time for more providers to get on board with the model, according to the post.                 

Healthcare delivery innovations, Trimble writes, fall on a spectrum, with the lowest-cost, least intensive options such as checklists for frontline staff at one end and large-scale projects such as opening new facilities at the other. In the middle lie ideas like the small-teams model, but these possibilities often go unmined, he writes, because of the mindset that true innovation is necessarily "big" and disruptive.

"This is part of the reason that these initiatives are easily overlooked: they appear, at first glance, plain and boring, not truly innovative despite the powerful results that they deliver," he writes.

To learn more:
- read the post