Development and Implementation of a Team-Based, Primary Care Delivery Model: Challenges and Opportunities Jay D. Mitchell, MD; Jordan D. Haag, PharmD, RPh; Eric Klavetter, MS, MA; Rachel Beldo, DNP, APRN, CNP; Nilay D. Shah, PhD; Lori J. Baumbach, MBA; Gerald J. Sobolik, MBA; Lila J. Rutten, PhD; and Robert J. Stroebel, MD Abstract In this article, we describe the implementation of a team-based care model during the first 2 years (2016-2017) after Mayo Clinic designed and built a new primary care clinic in Rochester, Minnesota. The clinic was configured to accommodate a team-based care model that included complete colocation of clinical staff to foster collaboration, designation of a physician team manager to support a physician to advanced practice practitioner ratio of 1:2, expanded roles for registered nurses, and integration of clinical pharmacists, behavioral health specialists, and community specialists; this model was designed to accommodate the growth of nonvisit care. We describe the implementation of this team-based care model and the key metrics that were tracked to assess performance related to the quadruple aim of improving population health, improving patient experience, reducing cost, and supporting care team’s work life. ª 2019 Mayo Foundation for Medical Education and Research n Mayo Clin Proc. 2019;94(7):1298-1303 A s primary care in the United States evolves from a volume-driven to a value-based reimbursement system, care delivery models for community-based practice must also evolve to ensure continu- ity of care. The patient-centered medical home was originally described by the Amer- ican Academy of Pediatrics and was designed to help achieve the triple aim of improving health outcomes, improving patient experi- ence, and controlling cost. 1-3 Certain elements of the patient-centered medical home, such as team-based care, have improved outcomes, including quality of care and provider satisfaction; however, a less consistent effect on cost of care has been documented. 1 TEAM-BASED CARE Team-based care, which is defined by the Na- tional Academy of Medicine as “the provision of health services to individuals, families, and/ or their communities by at least two health providers who work collaboratively with patients and their caregiversdto the extent preferred by each patientdto accomplish shared goals within and across settings to achieve coordinated, high-quality care,” 4(p5) is considered an essential feature of high- performance primary care. 2,4 A high- performance medical practice must achieve the quadruple aim of improving patient health outcomes, reducing health care costs, enhancing patient experience, and improving the work life of staff members. 2 We designed a team-based care model that can respond to the challenges of growing demand, increasing complexity, declining reimbursement, and shortage of primary care providers. Herein, we describe the implementation of a team-based care model, as well as design elements, imple- mentation efforts, and tracking of quality improvement data, after opening a new clinic. Institutional support for a physician to advanced practice provider (APP) ratio of 1:2 and the development of the “team manager” role were key to implementation. For editorial comment, see page 1135 From the Department of Family Medicine (J.D.M., R.B.), Department of Pharmacy (J.D.H.), Employee & Com- munity Health (E.K., L.J.B.), Division of Health Care Policy and Research (N.D.S., L.J.R.), Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (N.D.S., L.J.R.), Office of Population Health Management (G.J.S.), and Division of Primary Care Internal Medicine (R.J.S.), Mayo Clinic, Rochester, MN. BRIEF REPORT 1298 Mayo Clin Proc. n July 2019;94(7):1298-1303 n https://doi.org/10.1016/j.mayocp.2019.01.038 www.mayoclinicproceedings.org n ª 2019 Mayo Foundation for Medical Education and Research