“Who’s your doctor?” For generations, this question has been asked frequently in various situations (even socially).
Today, that question has evolved to “Who is your Primary Care Provider,” as the practice of medicine has changed to recognize the vital role of Advanced Registered Nurse Practitioners, Certified Nurse-Midwives, Physician Assistants and other clinicians. Historically we have identified our doctor (or primary care provider) as one person; the person who always cares for you, who knows you the best, the person you turn to in crisis and who helps you to navigate many of life’s important moments and decisions.
Although this relationship is still quite common today, in many cases this role has evolved from a single individual to a team of individuals who work together to take care of the patient.
Increasingly at the national level and medical institutions across the country people are talking about “Population Health,” an approach to medical care where a primary focus is keeping the patient healthy and out of the hospital and doctor’s office. This Population Health model is behind the shift to this team-based model of care where a team of providers “manage” the care of a patient in both sickness and in health. It’s not to say that providers ignored wellness before, but rather we were limited in our approach, resources and ability to help our patients stay well.
In recent years, there has been a national shift in the healthcare payment model that moves us away from the traditional fee-for-service payment structure to a new prospective payment that provides a financial incentive to promote wellness. This “lump sum payment” is all the money a provider receives for the year to take care of an individual patient. If it costs more to take care of the patient than the lump sum the provider was paid, there is no additional payment. Healthcare providers are now rewarded both professionally and financially to find ways to keep patients healthy, and the best way to do this is by having a team of people that can best address the broad spectrum of patients’ medical needs.
While this transition to a team-based model has happened, it has been met with mixed acceptance from patients and providers alike. Perhaps part of the hesitancy to embrace this model is the lack of a formal agreed upon definition of “team.” Some think of the team model as an advanced practice provider (Nurse Practitioner or Physician Assistant) matched up with a doctor who care for the patient together. Others view the team as the Primary Care Provider (advanced practice provider or doctor) and the specialists who care for the patient.
In my opinion, “team” should be defined as all of the medical professionals who care for the patients. This covers the person that checks you in at the front desk, the medical assistant who brings you into the exam room and briefly reviews your history, the nurses who take your telephone call when you are seeking medical advice, and all of the other people who are available to you based on your needs (pharmacists, nutritionists, social workers, home health, community agencies, specialists, etc.). Certainly, the leader of that team is your primary care provider. In short, the important relationship between you and your primary care provider has not changed, but rather the care you receive by your primary care provider and his or her team has been expanded and improved.
 Accountable Care Organizations, known as ACOs, are the vehicles that have allowed the care delivery model to change. Under this new model, primary care provider s are afforded the resources to provide wrap around, team-based care, care that might include help from a Care Manager, someone who can manage the psychosocial aspects of a patient’s care. It might also include community partners such as home health, elder care, and counseling services. We also now have access to RiseVT, a statewide (and local) organization that is working to improve the health of our community. Some of these services did exist prior to the shift in the care delivery model, but they had not been seamlessly integrated. Under the ACO umbrella there is more community collaboration and accountability for the service areas. Also, there are now better resources to help identify patients in need and be able to meet them where they are, by allowing them access to the health care system through traditional and non-traditional pathways.
Porter Medical Center has adapted to this shift and is utilizing all of these new resources to the advantage of patients in our area, and is now able to offer many different types of medical visits. For example, the hospital has technology that allows doctors to do video visits with patients, greatly improving access. This is appealing to the busy working professional who might have previously used “I have no time” as an excuse not to seek out preventative care, as well as those patients who have transportation issues or may not live close by to their primary care provider.
Care Managers also are a recent addition to our team at Porter. They are able to address the social needs that impede a patient is receiving medical care. Those social needs may be a lack of housing, stable job or income, insurance questions, or poor family supports.
Through the Blueprint for Health (the state-sponsored initiative), Porter is able to offer free visits with a nutritionist or a mental health provider. The hospital also has many self-management classes that are offered to help people in such areas as quitting smoking, managing or preventing diabetes, and improving emotional wellbeing.
As a physician, a consumer of health care, a mother, and a wife, I am truly amazed and thankful for this shift. I am able to provide the very best care for my patients for all of their needs as well as receive it for my family. It is a true honor to work at Porter, a place that is on the cutting edge of health care reform. So, I ask you to join me in embracing this new care model. I ask you to join me in letting go of the idea that there is one person and one person only who can handle your health care needs. If you have an urgent need, be open to seeing any provider that can see you at the moment you need to be seen. I ask you to embrace the enhanced definition of “team.”
If you have a wellness question, consider booking a wellness visit with your primary care provider or even take advantage of Porter’s free services.
Welcome to the team and I hope you can share in my excitement in being able to provide better care for you and our community!
Dr. Natasha Withers is medical director of primary care at UVM Health Network Porter Medical Center in Middlebury.