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Team approach to health care means new role for doctors

Sophie Quinton, Stateline.org on

Published in Health & Fitness

Carroll has about 300 patients, a fraction of the patient load of a typical doctor in a big health care system. He sits with patients for over an hour if he has to. He visits them at home. He helps them connect with social services and community organizations. And he can focus on what he loves most: teaching patients to eat a healthier diet.

His practice is proof that it's still possible for a family doctor to do it all. But he emphasizes that his experience is unusual. "I'm absolutely an outlier," he said.

Less than a quarter of all internal medicine doctors in the United States have a solo practice, according to the American Medical Association's latest survey. And although the model Carroll has embraced is growing, it serves a more affluent slice of the patient population than a major hospital system such as UCHealth.

The clinic where Lin and Peterson work, in Denver's Lowry neighborhood, is still in the early stages of transforming its teams. The best place in Denver to watch a diverse set of health professionals work together is across town, at a facility run by Denver Health, the city's public safety-net hospital system. The facility includes a primary care clinic, an urgent care center and a pharmacy.

"A lot of Denver Health patients are so complex," said Dr. Benjamin Feijoo, looking up from his desk. Patients often have multiple health issues, too many to handle in a typical 20-minute visit. "It's a bit of a crunch," he said.

So Feijoo turns to his colleagues for help. If a patient has both a medical and a mental health issue, Feijoo can address the medical problem and then ask a mental health specialist to step into the examination room. And if a living situation is compromising a patient's health, such as unstable housing, or insufficient access to healthy food, the clinic's social worker will try to find a solution.

The clinic also employs two community health workers, who spread the word about Denver Health in low-income neighborhoods, and a patient navigator, who calls the clinic's patients when they leave a Denver Health hospital and helps them schedule follow-up appointments with their primary care provider.

Denver Health began expanding its care teams in 2012, when it received a $20 million federal grant. The system spent about half the money on hiring staff such as social workers, patient navigators and clinical pharmacists. The rest was spent on software that identifies patients who are spending avoidable time in the hospital, including people who are homeless or have a serious but treatable condition, such as HIV. New, smaller clinics wrap even more services around those patients, allowing them to come in for visits that can last several hours.

The new system now saves Denver Health, an integrated system, which includes a health plan, so much money on hospital stays and emergency room visits that it covers the salaries of the additional hires, said Tracy Johnson, the director of health reform initiatives for the system.

Patients across the UCHealth system don't seem to mind the change. A few will ask to speak with their doctor in private, but others are more open with the medical assistant than with their doctor. "Sometimes, they don't feel as judged," Peterson said.

Lin said that since he's started working with Peterson, his patients have been better able to keep their blood pressure and diabetes under control. "Patients will forget to tell me that they're out of prescriptions," he said -- or he'll be so busy tackling a more immediate problem that he'll forget to ask.

With a medical assistant methodically asking all the opening questions, crucial details such as prescription renewals no longer slip through the cracks.

(This story was a collaboration between Stateline and Politico.)

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