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Health care reform, market forces drive increase in interprofessional education

September 07, 2015

By Kimber Solana

Dr. Valachovic

Dr. Spielman

Dr. Friedrichsen
Editor’s note: This is the second in a series of ADA News articles on interprofessional education

In 2005, when Western University of Health Sciences was set to expand, adding four new colleges, including the College of Dental Medicine, the deans of the existing and new colleges made a key decision — make a commitment to add interprofessional education in its curriculum.

“It was a bold move to consider university-wide incorporation of IPE,” said Dr. Steven Friedrichsen, professor and dean of the College of Dental Medicine. “Very few other programs in the country had recognized its value at the time and so there were very few, if any models to look at.”

Although there’s literature around team-based care going back 40 years, it wasn’t until less than 10 years ago that more and more universities began adopting IPE, a teaching model, though it varies by institution, that educators around the country say is becoming more necessary as health care reform continues to reshape the future of health care delivery and focus.

“Our data indicate that about 90 percent of dental schools offer some form of formal IPE coursework today,” said Dr. Richard Valachovic, president and CEO of the American Dental Education Association. “There were few dental schools with formal IPE program just five years ago.”

Education leaders cite health care reform that sought to improve quality of care while reducing cost and a variety of market forces in play as reasons why IPE has become part of a culture in health professions’ education and practice.

More practitioners becoming employees

“The difference today, first, is there are ongoing changes in the health care system,” Dr. Valachovic said. “The trend in health care, in general, is moving to large health care systems instead of individual physicians.”

Dr. Valachovic said large health care systems have recognized that team-based care results in significant cost savings and improved patient outcomes. The year 2012, he said, was the first year that more than 51 percent of all physicians are employees and not independent practitioners.

Recognizing the trend in 2005 led New York University to begin looking at IPE prior to the merger between the colleges of nursing and dentistry.

Dr. Michael Alfano, dean of NYU’s College of Dentistry at the time, and Terry Fulmer, Ph.D., dean at the time of NYU’s newly formed College of Nursing, saw a shift in the way medicine was being practiced — more physicians were employees.

“They saw that nursing and dentistry were likely to follow suit in that trend,” said Dr. Andrew Spielman, professor and associate dean for Academic Affairs at NYU College of Dentistry, adding that more dentists will likely work in health care systems where dental care was only one service provided by a larger team-based model.

“They realized they needed to prepare their students and make sure they’re ready to adapt to these shifts,” he said.

In addition, when Dr. Spielman compared the nursing and dental programs at NYU, he found that 38 percent of the competencies in the dental school were also listed in the nursing program.

“That’s not a small number,” he said. “Today, 71 percent our competencies reflect that in the nursing program.”
These competencies include duty, altruism, communication skills, leadership, self-assessment, life-long learning, compassion, evidence-based practice and patient-centered care.

Health care reform

A second reason for the rise in IPE is the Affordable Care Act, where throughout the law, team-based and collaborative care are often mentioned. The ACA implemented accountable care organizations, which are groups of doctors, hospitals and other health care providers who come together voluntarily to give coordinated high quality care to their patients.

The goal of coordinated care, according to the U.S.Centers for Medicare & Medicaid Services, is to ensure that patients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical errors. In essence: Improve the quality of care provided while lowering health care costs.

“As a result, we’ve come away from the isolated practice environment,” Dr. Valachovic said. “This enhances the team-based approach and drive the need for IPE.”

When WesternU incorporated IPE in its curriculum, much of what was initially implemented for the course was based on what their clinical faculty observed in the patient care arena, said Dr. Friedrichsen.

“They basically said, ‘What skills and attributes would lead to improved care for the patient by all of our graduates?’ and then translated that into the embryonic curriculum,” he said.

Today, the ultimate purpose for dental students at Western University to participate in IPE is to improve patient care across the entire spectrum of health care, and at the same time reduce the cost.

“Interprofesional education is actually the first step toward interprofessional collaborative practice,” Dr. Friedrichsen said. “We hope that students will take away enhanced communication skills with other healthcare professionals, an understanding of the intersection points common to multiple healthcare providers as well as a broader understanding of team dynamics and issues of quality and patient safety.”

Other reasons for IPE’s rise

If Dr. Valachovic was to pinpoint where the recent quick growth of IPE programs began, it was when the Interprofessional Education Collaborative released its Institute of Medicine report, “Core Competencies for Interprofessional Collaborative Practice,” in 2011.

The report highlighted the value of IPE and team-based care — allowing health professions schools around the country to seriously consider IPE programs, said Dr. Valachovic.

But there are other reasons for the swift implementation of IPE programs.

Dr. Valachovic said large managed health care systems, such as Kaiser Permanente, have recognized the significant cost savings and improved patient outcomes through team-based care.

In addition, in recent years, accrediting bodies of the health professions have included IPE components in their accreditation standards.

In 2013, the Commission on Dental Accreditation implemented a revision to its Accreditation Standards for Predoctoral Dental Education Programs, adding that “graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care.”

One of the biggest challenges, Dr. Friedrichsen said, is helping students see beyond today’s historically siloed health care and reimbursement systems.

“As we come closer to shared component of a universal electronic health record, we can see a pathway to the co-management of patients at every point in the health care system,” he said. “Think of the possibilities if the blood pressure readings, glucose levels, tobacco use and medication compliance from the physicians, dentists, pharmacists were all combined and readily available in one location and a common format.”

Aggregating various health care information of patients and using it in care systems informed by interprofessional training could lead to more successful management of hypertension, control of weight, diabetes and other diseases.

“Maybe we could make a dent in the statistics related to oral cancer with more informed eyes looking for early detection and intervention,” Dr. Friedrichsen said.

“It’s trendy,” said Dr. Spielman said of IPE. “But there are individuals who see IPE as the right thing to do, and we are making sure our graduates are prepared for the next 10-15 years.”