The tension between accomplishing some of the aims of Obamacare to reduce healthcare costs and the diminishing number of physician practices is giving way to a certain amount of experimentation with healthcare business models. In the latest example, Independence Blue Cross and DaVita’s physician practice arm have collaborated to launch a new business called Tandigm Health.
It will build a network of primary care physicians who will get higher reimbursement. In return, the physicians need to reduce chronic condition costs by working to keep these patients out of the hospital.
Diabetes, congestive heart failure and pulmonary disease are among the chronic conditions primary care physicians will treat. Tandigm Health, led by IBX senior vice president Anthony Coletta, will give doctors in the Philadelphia area analytical tools and access to real-time data to help patients do a better job of managing their condition. It will also provide monitoring tools to help patients stay out of the hospital and in their own homes.
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IBX will allocate a portion of member premiums to doctors in the network. The idea is to better equip primary care doctors and hospital systems to make decisions about patient care, reducing duplicate services and improving patient satisfaction. Although it sounds a bit like an Accountable Care Organization, a spokeswoman for IBX emphasized that it’s not.
Tandigm’s goal is to have 300 physicians by next year.
Although DaVita is a dialysis provider, it added a doctor group — HealthCare Partners — in 2012 to the tune of $4.42 billion.
Philadelphia has some of the nation’s highest healthcare costs. Hospital admissions in the Philadelphia region for people under 65 are the highest among the nation’s largest metropolitan areas and 25 percent higher than the national average, according to data from Milliman.
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It’s possible that some of the tools IBX has been developing to improve insights on patient care could be among those made available to the primary care physicians in the network. One project with Penn Medicine explored using financial incentives and other tools to improve medication adherence and to reduce hospital re-admissions among patients with acute myocardial infarction. This patient population has a notoriously low adherence rate, which inevitably causes complications.
