Team Based Care Model

Team Based Care Model

The growing trend towards a team based care model is here! Or maybe in some instances the team based care model is back after being decimated by the COVID-19 pandemic. And this bodes very well for operators and especially for our residents in long term care. Nursing facility consumers in light of the pandemic have been much more vocal and demanding about the kinds of care and services they want in nursing facilities. Team based care is comprised of optimal on- site clinical presence (providers and provider assist) as well as effective, collaborative clinical approaches to improve overall care. A true team based care model is not only reasonable but essential for overall patient satisfaction, patient care, compliance, facility reimbursement and ultimately for facility sustainability. And many operators are listening. Mostly because it just makes sense.


With data now demonstrating a pandemic assisted increase in overall clinical (provider and provider assist) full- time staff hires (currently most notably in urban areas) residents will likely see much more on- site clinical care presence in facilities moving forward. And other industry trends are leading the charge towards a comprehensive team based care model approach as well.

The Skilled Nursing Facility Value Based Purchasing Program (SNF VBP Program) developed by the Centers for Medicare and Medicaid awards nursing facilities with incentivized payments for quality care (hospital readmission measure). This of course is only an initial step towards an overall developing model that ties in care quality to reimbursement – certainly an area that would benefit from a comprehensive team based care approach. 
The relatively new PDPM Medicare Part A reimbursement methodology was designed to promote absolute clinical collaboration on realistic patient clinical characteristics to ensure appropriate care service provision, compliance and appropriate reimbursement. 

Technology advances today are being increasingly utilized as part of a team based care model and are demonstrating improved efficiency and effectiveness in assisting nursing facilities to optimize appropriate reimbursement and compliance. Advanced technology is also proving to be incredibly effective in helping facilities to implement team based care in resident risk management programs to objectively predict adverse outcomes and ensure timely and effective services for improved quality. 

Microscope_Team_based_care.jpgFacilities are understanding and implementing a team based care model approach with upstream (providers and hospitals) and downstream (Home Health and Community Based Services) partnerships to help to ensure continued referrals, safe handoffs and to help ensure service quality in the care transitioning continuum.

Despite the ongoing challenges with finances and COVID-19 impacts nursing home operators who champion a true team based care model by incorporating greater on-site physical clinical presence and collaborative processes and tools to foster effective collaborations can expect greater consumer satisfaction, improved patient care, good outcomes, regulatory compliance and optimized reimbursement for improved financial health. 

As part of a commitment to a team based care model operators would do well to look towards Microscope as a trusted partner for solutions including ourOPTICS Innovative Technologyto improve finances, compliance and care quality. 

For more information please contact:

Michael F. Masse, OTR/L, Senior Director - Long Term Care / Continuing Care

mmasse(at) / 607.316.6576

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