A conceptual framework for interprofessional and co-managed care.

Interprofessional care has been promoted by some policy makers and health professionals as a response to rising health care costs and threats to patient safety. Proponents suggest that interprofessional models of care can reduce fragmentation and lower costs through improved coordination between different health professionals. These models encourage the collaboration of supplementary skills between different health care professionals. Effective collaborative models of interprofessional care may be influenced by several variables germane to the interaction and structure of the team of health professionals--temporality, urgency, and degree of structured authority--and the author examines the importance of each variable in delivering interprofessional care. Co-managed models of care have also been proposed. Recent state health reform efforts have catalyzed the adoption of co-managed care models by expanding the autonomy of alternative providers through the broadening of scope of practice. These scope-of-practice changes are intended to permit greater diagnostic and therapeutic authority of nonphysician providers. This effort seems aimed at enhancing the competition between provider groups in the market and expanding consumer choices. Herein, the author presents a conceptual framework to describe different models of interprofessional and co-managed care. The author also considers interprofessional and co-managed care models in the context of the health reform movement. Some of the challenges are considered, as policy makers consider the options for facilitating further development of interprofessional models of practice and the implications for curricular modifications at academic health centers.