Redesigning care delivery with patient support personnel: Learning from accountable care organizations

摘要

Introduction Accountable care organizations are a value-based payment model in the United States rooted in holding groups of health care providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, accountable care organizations implement a variety of care delivery changes, including workforce redesign. Patient support personnel—nonphysician staff such as care coordinators, community health workers, and others—are critical to restructuring care delivery. Little is known about how accountable care organizations are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. Methods We conducted semi-structured 1-h interviews with 25 executives at 16 distinct accountable care organizations. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. Results Accountable care organizations deployed patient support personnel to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. Accountable care organizations deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care, and community) depending on their population needs. Most accountable care organizations used personnel with the same level of training across settings. Few accountable care organizations planned to conduct a comprehensive evaluation of their patient support personnel to optimize their value. Discussion Accountable care organization strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of patient support personnel and their performance is needed to demonstrate cost-saving benefits of workforce redesign.