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The CAPC Payment Accelerator: A Joint Virtual Work ...
CAPC Staffing Models Summary
CAPC Staffing Models Summary
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Home-based care programs, operating under fixed payment models, benefit from innovative staffing approaches that minimize reliance on billable clinicians. This document evaluates the three principal staffing models: NP-SW Team with MD Oversight, RN-SW Team with MD/NP Oversight, and Mixed Models to understand their benefits, costs, disadvantages, and practical implementations.<br /><br />**NP-SW Team with MD Oversight Model:**<br />- *Structure:* Interdisciplinary teams led by nurse practitioners (NPs), supported by social workers (SWs), and overseen by a lead physician (MD).<br />- *Pros:* NPs offer immediate patient care, including prescribing and conducting assessments. Flexible co-management with primary physicians is possible.<br />- *Cons:* Higher staffing costs relative to RN-led models. Some physicians may prefer MD coordination.<br />- *Case Study:* Aspire Health utilizes NPs, SWs, and additional telephone and community health support, managing patient visits and follow-up calls.<br /><br />**RN-SW Team with MD/NP Oversight Model:**<br />- *Structure:* Led by registered nurses (RNs) who address clinical needs, supported by SWs, and overseen by MDs or NPs.<br />- *Pros:* Lower staffing costs. Can function as primary caregivers in a co-management model.<br />- *Cons:* RNs cannot prescribe, requiring additional care hand-offs. Telehealth investment may be necessary for scaling.<br />- *Case Study:* ProHEALTH Care Support stratifies patients by risk levels, offering varied visit frequencies and employing volunteers for additional support.<br /><br />**Mixed Models:**<br />- *Structure:* Combines NPs, RNs, and SWs. In Model A, NPs conduct initial assessments, transitioning care to RNs. In Model B, NPs focus on complex cases while RNs handle lower-risk patients.<br />- *Pros:* Flexibility to meet unique patient needs and accommodate different payer requirements.<br />- *Cons:* Complexity in managing multiple contracts and protocols. <br />- *Case Studies:* Arizona Palliative Home Care and Hospice Buffalo demonstrate stratified care approaches, adjusting visit frequencies by patient risk levels.<br /><br />**Additional Considerations:**<br />Risk stratification is key in determining visit frequency and care intensity. Programs often provide 24/7 telehealth support and conduct interdisciplinary team meetings to maintain coordinated care. Staffing adjustments are essential based on particular patient needs and geographic considerations. <br /><br />Utilizing these models with structured communications and support functions enhances care quality while enabling clinicians to manage increased patient caseloads efficiently.
Keywords
home-based care
fixed payment models
staffing approaches
NP-SW team
RN-SW team
mixed models
risk stratification
telehealth support
interdisciplinary teams
patient care
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