This article is sponsored by TeamHealth. In this Voices interview, Skilled Nursing News sits down with Dr. Teizu Wolokolie, Regional Medical Director, Post-Acute Care, TeamHealth, to provide insight and perspective into the value of establishing relationships across the continuum, and how it improves communication, clinical outcomes, and develops an overall sense of community in the health care ecosystem. She also explains why care transitions are integral to patient-centered care and reducing re-hospitalization rates at a facility.
Skilled Nursing News: What life and career experiences do you most draw from, in your role today?
Dr. Teizu Wolokolie: I am fortunate to have a diverse blend of personal and professional experiences to draw from in different scenarios in my day-to-day. I started my career as a hospitalist in both community and tertiary care hospitals, then transitioned to post-acute where I served as an attending physician, facility medical director, chief medical officer, and chief operating officer.
The experience from each of these roles coupled with my current role at TeamHealth allows me to leverage clinical and operational expertise and a deep understanding of both the acute and post-acute health systems. Having navigated the health care system as a patient, as a mother of a special needs child, and as a daughter to elderly parents, I draw on all these experiences to effectively pursue the quadruple aim in health care — improving patient experience, improving population health, reducing the cost of care, and improving clinician satisfaction.
Why are care transitions integral to patient-centered care?
Care transitions are critical to patient-centered care because they enable the delivery of high-quality health care across various settings. When executed well, seamless care transitions enhance patient safety, improve patient experiences, and promote efficient resource utilization. Effective care transitions help prevent common errors like missed appointments, misdiagnoses and medication disparities while minimizing redundancy in care and avoidable re-hospitalizations. This provides patients with a better experience during what is often a tumultuous and vulnerable period in their lives.
By ensuring a smooth transition with minimal delays and disruptions, patients feel empowered as they move to the next phase of care. This is essential for continuity of care and improving outcomes across the board, which is why it’s a priority in TeamHealth post-acute care.
What are some of the most common challenges to care transitions, and how can SNFs improve them?
There are several challenges associated with care transitions, but I think technology is a good starting point. Technological limitations that hinder access to patient medical records across different care settings can lead to medication errors, misdiagnoses, increased costs, and confusion about treatment plans. It also complicates real-time communication among health care team members, which can affect HIPAA compliance.
Additionally, time constraints and communication challenges have a significant impact on providers’ ability to perform comfortable handoffs to appropriate clinicians during transfers. I’ve seen patients consistently experience better outcomes when there is effective communication between transferring and receiving care providers, such as hospitalists, emergency room physicians, primary care physicians, or specialists involved in the patient’s care.
Operating in silos is another major challenge. Despite proximity, different care settings often have a limited understanding of each other’s capabilities, resources, regulatory and infrastructural constraints, and medical staff accessibility. If health information exchange platforms were utilized more effectively, they could enhance the coordination of care by allowing secure, efficient communication of medical information.
Secure texting platforms can minimize variability and save time in this area, but it is also beneficial to invest in education to help teams understand the different settings across the continuum. On the other side of the spectrum, educating patients about what to expect as they transition between care settings can also mitigate many of the challenges encountered during care transitions.
How do relationships within the community directly contribute to enhancing patient care or streamlining transitions between different care settings?
Relationships within the community are crucial to enhancing the experience of care transitions. To improve seamless transitions of care, we must break out of our silos and strengthen communication among all care providers. For example, if a primary care physician in the community, a hospitalist, an emergency room physician, or a community subspecialist is aware of who is providing care for a mutual patient, this awareness facilitates the exchange of information and promotes harmonious care.
At TeamHealth, we do our best to reassure the patient by familiarizing them with the medical team and maintaining an open line of communication with their providers. This enhances the patient’s experience and reduces the likelihood of an unnecessary transfer back to the hospital due to patient requests.
Including a patient’s primary care physician in communications often facilitates the patient’s engagement in their treatment plan. Further, building relationships that extend beyond the medical team is equally important because it allows access to community resources and additional support for patients.
What role does the transition of care play in lowering re-hospitalization rates at a facility along with the total cost of care?
Transitions of care executed with a focus on coordinated and comprehensive care for the patient are critical to reducing re-hospitalization rates. Effective coordination of follow-up care with specialists and primary care providers upon discharge, along with medication reconciliation and education of patients and their families, creates a foundation for an uninterrupted stay in skilled nursing facilities. These practices not only impact the total cost of care by reducing the likelihood of readmission, but they also decrease potential patient morbidity and the labor costs associated with fractured care.
How would you summarize the overarching importance of fostering collaborative relationships within the health care ecosystem to achieve patient-centered care excellence in post-acute care settings?
Collaborative relationships cultivate superior outcomes, efficient resource utilization, quality improvement in process, and improved patient safety and experience. TeamHealth also provides comprehensive support and resources to health care teams, enhancing their ability to deliver coordinated and effective patient care, which allows us to achieve patient-centered excellence in the post-acute setting.
Finish this sentence: “In the skilled nursing industry, 2024 will be defined by…”
… the success of those pursuing and achieving the quadruple aim of improving patient experience, improving population health, reducing cost of care, and improving clinician satisfaction.
Editor’s Note: This interview has been edited for length and clarity.
TeamHealth offers full-service, post-acute clinical practice management to partners nationwide. Our clinical and operational practice models can be tailored to our partners’ unique needs, making it the optimal solution for skilled nursing facilities, life plan and continuing care retirement communities and assisted living and independent living communities. To learn more, visit teamhealth.com/post-acute.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].