Leveraging Interprofessional Team-Based Care Toward Case Management Excellence

Abstract

Health care teams continue to be a constructive way to approach, assess, coordinate, plan, and facilitate the care of clients and populations. Independent of practice setting, some type of team is in place, engaging different professionals and specialists. There has been considerable evolution of these teams over the years, with a heritage of terms to frame each one, including “multidisciplinary,” “interdisciplinary,” and “transdisciplinary.” However, these long-standing framings have been replaced by a timelier model that shifts both focus and aim of the team effort. Interprofessional team-based care (IPTBC) sets the tone for how students entering the industry are educated and empowers the workforce to a more intentional means to the care end. This is the first in a 2-part series focusing on the evolution and implementation of IPTBC across the industry. Part 1 focuses on the history and fundamental concepts of interprofessional models. Evidence and outcomes to promote the value proposition for IPTBC implementation are also provided. Purpose/Objectives: This article: Reviews the evolution of health care teams;Defines IPTBC;Discusses the challenges to implementation of IPTBC; andIdentifies the implications for professional case management. Primary Practice Setting(s): Applicable to all health and behavioral health settings where case management is practiced. Findings/Conclusions: Interprofessional team-based care models demonstrate a successful means to achieve client-driven, quality, and cost-effective care across disease states and practice settings. Implications for Case Management Practice: With case management so closely linked to the fiscal imperatives of organizations, engagement in IPTBC is a necessity for every practice setting. Poor team collaboration contributes to unsuccessful outcomes for clients, increased costs, and concerning quality and risk management issues for the organization. The latest generation of value-based care initiatives and complex population health needs (e.g., social determinants of health, co-occurring physical and behavioral health) translates to greater pressures on case managers to maximize financial risk and attain their share of financial incentives (e.g., bonuses, shared savings) by avoiding readmissions, preventable complications, and duplicate services.

Healthcare Teams: Terminology, Confusion, and Ramifications

“…The terms observed most frequently include unidisciplinary, uniprofessional, intradisciplinary, intraprofessional, multidisciplinary, multiagency, interdisciplinary, interprofessional, interprofessional collaboration, cross-disciplinary, transdisciplinary, transprofessional, and supra-disciplinary ( Table 1 ). 1 , 2 , 6 , 7 , 11 , 12 , 17–26 These terms are used interchangeably and defined inconsistently throughout the literature. Notably, the suffixes “discipline” and “profession” are also used interchangeably despite distinct definitions where “discipline” refers to a body of scientific knowledge, and “profession” is defined as an occupation in which qualified professionals are committed to a shared vision.…”

“…Many authors agree that MDTs frequently communicate via the physician (or the highest ranking professional), meaning that formal team meetings are not required, and other team members work in parallel or sequentially and therefore may not communicate between themselves at all. 6 , 7 , 12 , 14 , 20 Conversely, some authors suggest that all MDT members collaborate, share information and skills, and develop shared patient-centered goals. 19 , 21 , 22 The latter description aligns more closely with interdisciplinary teams and interprofessional teams.…”

“…The composition of MDTs is described more consistently in the literature as a team of professionals from multiple disciplines, who bring a unique discipline perspective but function independently from one another. 1 , 6 , 12 , 17 , 18 , 20 , 22 Many authors suggest that patient assessment, goals, and treatment are discipline-specific which, due to differing discipline perspectives represented within the team, could lead to contradictory expectations of clinician-directed goals and treatments. 6 , 7 , 18 …”

“… 1 , 6 , 12 , 17 , 18 , 20 , 22 Many authors suggest that patient assessment, goals, and treatment are discipline-specific which, due to differing discipline perspectives represented within the team, could lead to contradictory expectations of clinician-directed goals and treatments. 6 , 7 , 18 …”

“… 25 This definition matches some of the characteristics associated with IDTs and IPTs, which are frequently described to include members with different professional perspectives who work in a patient-centered, interdependent, and collaborative manner to share knowledge and decision-making, develop shared plans, and achieve common goals. 6 , 7 , 12 , 18 , 20–22 , 28 Importantly, patient-centered care occurs when healthcare professional/s partner with the patient (or their representative) and integrate patient preferences, needs, experiences, and goals into every phase of care. 29 At the extreme end of patient centered care, a patient (or their representative) could be considered as an equal team member.…”