A conceptual framework for interprofessional and co-managed care. 2008

Sheldon M Retchin
Virginia Commonwealth University, Richmond, Virginia, and chief executive officer, VCU Health System, Richmond, Virginia 23298-0549, USA. retchin@mcvh-vcu.edu

Interprofessional care has been promoted by some policy makers and health professionals as a response to rising health care costs and threats to patient safety. Proponents suggest that interprofessional models of care can reduce fragmentation and lower costs through improved coordination between different health professionals. These models encourage the collaboration of supplementary skills between different health care professionals. Effective collaborative models of interprofessional care may be influenced by several variables germane to the interaction and structure of the team of health professionals--temporality, urgency, and degree of structured authority--and the author examines the importance of each variable in delivering interprofessional care. Co-managed models of care have also been proposed. Recent state health reform efforts have catalyzed the adoption of co-managed care models by expanding the autonomy of alternative providers through the broadening of scope of practice. These scope-of-practice changes are intended to permit greater diagnostic and therapeutic authority of nonphysician providers. This effort seems aimed at enhancing the competition between provider groups in the market and expanding consumer choices. Herein, the author presents a conceptual framework to describe different models of interprofessional and co-managed care. The author also considers interprofessional and co-managed care models in the context of the health reform movement. Some of the challenges are considered, as policy makers consider the options for facilitating further development of interprofessional models of practice and the implications for curricular modifications at academic health centers.

UI MeSH Term Description Entries
D007388 Internal Medicine A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. General Internal Medicine,Medicine, Internal,Internal Medicine, General,Medicine, General Internal
D007400 Interprofessional Relations The reciprocal interaction of two or more professional individuals. Etiquette, Medical,Medical Etiquette,Relations, Interprofessional
D008297 Male Males
D008329 Managed Care Programs Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS. Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D010348 Patient Care Team Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. Health Care Team,Interdisciplinary Health Team,Medical Care Team,Multidisciplinary Care Team,Multidisciplinary Health Team,Healthcare Team,Care Team, Health,Care Team, Medical,Care Team, Multidisciplinary,Care Team, Patient,Care Teams, Health,Care Teams, Patient,Health Care Teams,Health Team, Interdisciplinary,Health Team, Multidisciplinary,Healthcare Teams,Interdisciplinary Health Teams,Medical Care Teams,Multidisciplinary Care Teams,Multidisciplinary Health Teams,Patient Care Teams,Team, Health Care,Team, Healthcare,Team, Interdisciplinary Health,Team, Medical Care,Team, Multidisciplinary Care,Team, Multidisciplinary Health,Team, Patient Care,Teams, Interdisciplinary Health
D011050 Policy Making The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. Analysis, Policy,Policy Analysis,Policy Development,Analyses, Policy,Development, Policy,Developments, Policy,Making, Policy,Policy Analyses,Policy Developments
D004502 Education, Medical, Continuing Educational programs designed to inform physicians of recent advances in their field. Medical Education, Continuing,Continuing Medical Education,Education, Continuing Medical
D005260 Female Females
D006291 Health Policy Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. Health Care Policies,Health Policies,Healthcare Policy,National Health Policy,Care Policies, Health,Health Care Policy,Health Policy, National,Healthcare Policies,National Health Policies,Policies, Health,Policies, Health Care,Policies, Healthcare,Policy, Health,Policy, Health Care,Policy, Healthcare
D006302 Health Services Research The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed) Health Care Research,Medical Care Research,Research, Health Services,Action Research,Health Services Evaluation,Healthcare Research,Research, Medical Care,Evaluation, Health Services,Evaluations, Health Services,Health Services Evaluations,Research, Action,Research, Health Care,Research, Healthcare

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