The use of a team-based approach to providing health care is at the core of most, if not all, of the new delivery models being tested and developed. Figuring out how a care team should be structured within a given organization is a major task, one that is likely to result in a multitude of approaches being adopted to suit the circumstances.

Of course, some deeply entrenched beliefs will also significantly influence how care teams are formed. At their annual meeting this week, American Medical Association members endorsed a resolution reaffirming the group's belief that "the ultimate responsibility of patient medical care rests with the physician and thus advocates that physicians maintain authority for patient care in any team-care arrangement to ensure patient safety and quality."

In a release, AMA President Ardis D. Hoven, M.D., said that the policy "will help physicians transition to new care models by promoting flexibility to develop practice designs based on physician needs, the populations they serve, relevant state laws and protection from the burdens that would come from a one-size-fits-all approach."

In a world of limited human and financial resources though, placing such limits on the structure of care teams may not be realistic. In some instances, it will be more efficient for another type of provider — such as a nurse practitioner — to oversee the care. Along those lines, Duke University has created a care coordinator program designed for nurses.

We're likely to see both approaches and others in use for the foreseeable future. For a story in June's Hospitals & Health Networks magazine, I spoke to health care providers using both approaches. University of Pittsburgh Medical Center uses nurse practitioners to oversee care for post-acute patients, while Atrius Health relies on physicians dedicated to patients in skilled nursing facilities.

That is just one part of the decision-making needed to create a care team, and providers are using varied structures to do so. You can find more examples in a guide published by affiliates of the American Hospital Association. Details on team-based approaches from AtlantiCare Health System, Brigham and Women's Hospital and Marquette General Health System are in the guide, with each having its own take on team-based care.

It'll take years for a standard or consensus on how to structure a care-based team to take hold, so for those putting together and designing new care team models, you're on your own to a certain degree.

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