All in One Setting: Integrated Team-Based Care for Autoimmunity

Dr. Susan Manzi (left) and Jenna Boswell (right) discuss treatment for a patient under their joint care.

During an office visit if a patient shares feelings of depression or anxiety, Susan Manzi, MD, MPH, rheumatologist and chair of the Medicine Institute at the Allegheny Health Network (AHN), can simply open a door to invite behavioral health consultant Jenna Boswell, MS, LPC, to join the appointment and provide acute intervention on the spot.

Such a timely and coordinated response to a patient’s behavioral health is very different from the standard process. Typically, a rheumatologist provides the patient with a referral for mental health support that will occur on a different day, in a different location, with little interaction between the two providers.

Dr. Manzi also has access to acute interventions from other team providers, including a pharmacist who can help a patient refine a plan for adhering to medication.

“The traditional healthcare model is broken, especially for people who navigate healthcare for a chronic condition requiring a number of specialists and visits,” Dr. Manzi says. “Many barriers to good outcomes in medicine are unrelated to the disease itself, but more [related to] social determinants of health. Most [rheumatologists] are not equipped to address these difficult issues. And when we try, it often stretches us thin and leads to burnout. That’s why we are working to transform a new care approach for our patients with autoimmune conditions.”

Bridging Gaps in Care
The AHN’s Autoimmunity Institute launched in the spring of 2018, with the opening of a new clinical and research facility dedicated to autoimmune care, where Dr. Manzi and her colleagues are implementing a new model of integrated services. This model includes a physical care environment that literally breaks down the walls between providers.

At the Autoimmunity Institute, no one has an office. Instead, every provider on the care team, which includes a rheumatologist, pharmacist, behavioral health specialist, social worker and nurse navigator, shares an adjacent, open workspace surrounded by patient rooms.¹ This office configuration supports collaborative provider pre-visit huddles to discuss patients scheduled for that day and post-visit huddles to assess next steps for integrated care.

Between office visits, providers have open access to team members for acute interventions and patient introductions for follow-up care. This unique model also incorporates specialists in dermatology, nephrology, pulmonology, gastroenterology, allergy, endocrinology and integrative medicine services, such as acupuncture and massage therapy—all in the same location.