August 3, 2015

The New Primary Care Trend: Team-Based Care


The New Primary Care Trend: Team-Based Care

Across the country, many primary care clinics are changing how they do business. The practice of team-based care is catching on in Indianapolis, too.  Its advocates say the approach is good for patients -- and doctors.  

When a patient calls to schedule a doctor appointment at Eskenazi’s Pecar clinic on North Michigan Road, chief executive physician Dawn Haut says that may not be what the person needs. 

For the last year and a half, the Pecar team- made up of doctors, nurses, mental health and dietary professionals, an attorney and financial advisor - has piloted a new kind of case management conference before the patient ever comes through the door. 

“Because we're prepared for the visit - we know what they're coming in for - everyone knows what their role is - then the doctor just becomes one of a string of people that need to go in and everyone addresses their part of it. That’s where we’re getting stuff done,” Haut said.  

Haut said having all these services available in one spot means patients are getting care they might not otherwise get. She tells the story of diagnosing a teen with depression, and then walking her down the hall to meet the Midtown Mental Health professional.  

“It's immediate so a lot of the stigma of saying, 'Yes, you need to go see a psychologist or a psychiatrist and I'll put the referral in,'" Haut said. "And then they have to go drive somewhere separate for that and go somewhere where there's a big sign that says psychiatrist - you know - that's all gone.”

Haut, who's a pediatrician, says she knows  how difficult it can be for parents to get off work to bring their kids to the doctor, or for poor or elderly people to get transportation – so it’s important to address as many needs as possible, in an efficient way.   

“Down those two giant hallways, there's all kinds of stuff in here. We have a pharmacy. The Marion County Health Department northwest district office is located here. We have a dental clinic. We have a WIC office. We have a food pantry that's brand new.”

Haut calls team-based care a huge paradigm shift for primary care. She says primary care providers don't make as much money as specialists, but they carry huge workloads. She says team-based care helps reduce physician burn out by giving doctors a new sense of accomplishment and a feeling they’re making a bigger difference in patients' lives. 

Tim Lannan is one patient who's benefitted from having Midtown Mental Health professionals embedded at Eskanazi clinics.  Last fall, he was violently ill from all his excessive drinking. And during an appointment with the doctor, he said he'd given up on life. That was a turning point.  

“I got introduced to Mary Beth of Midtown. She walked in the office and for some reason - you know - I've talked to many, many counselors and therapists and so forth - she just was an incredibly easy person to talk to. Besides being nonjudgmental, she was a great listener and said some things that caught my attention that nobody had said before," he said.

Drug and alcohol abuse began taking its toll on Lannan from the time he was 14.  He later flunked out of IU Bloomington, but he says his tailspin really began at age 26, when his father died.  when he was 26 and his father died.  He's 48 now, and over the years he's struggled with depression, cocaine addiction, unemployment and homelessness.  Lannan said he voluntarily sought treatment often but he couldn’t stay sober.

Even last October, he was reticent to try the group therapy at Midtown but has found it to be the most rewarding experience – getting support and helping others from various backgrounds dealing with the same issues he faces every day. 

“It's so overwhelming to think that, you know, you have this disease that there's no cure for - and you're going to have it for your entire life. But to break it down day to day and have some skills that they teach at Midtown - life skills and breathing skills and meditation and things that you help you in the moment of high stress - cause that's usually the biggest trigger of all," Lannan said. "But I have to say that I feel positive today. I feel like, uh, I actually have a future. I just haven't felt that way in many years.”

The team-based care trend is catching on in Indianapolis. Franciscan St. Francis Health Weight Loss Specialists has a mental health professional on staff. Community Physician Network has 9 hub sites with team care, IU Health provides care managers to patients with Health Plan or Marketplace insurance and St. Vincent hospital primary care physicians are moving to team-based care this year.

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