Opinion: Leading change through value-based care

It's no secret that the U.S. healthcare system is in desperate need of improvement. In fact, according to The Commonwealth Fund's International Health Survey results, the United States ranks last in overall healthcare quality, access, and cost measures in comparison to eleven other industrialized countries. Despite spending trillions of dollars annually to improve the health of our nation, we have not been able to provide the quality of care that U.S. patients deserve.

After spending two decades as a general surgeon in the Philadelphia area, one of the most expensive healthcare markets in the United States, I saw the problems with the current system firsthand. It became clear to me during this time that there was a need for a new healthcare model to provide physicians with the tools and resources necessary to deliver coordinated, proactive, high-quality care. Specifically, there was, and still is, a need to put primary care physicians (PCPs) back at the center of care. Today, only 30% of all physicians practice primary care. In most other developed countries, PCPs represent 70%, which is reflective of numbers in the United States 50 years ago. Primary care physicians are vital in addressing health problems early and helping patients avoid costly—and often unnecessary—emergency room visits or hospitalization. 

A positive disruptor

To address these growing needs within our country’s healthcare landscape, Independence Blue Cross and DaVita Healthcare Partners came together in 2014 to launch Tandigm Health, a value-based healthcare company supporting primary care physicians. After a successful first year in 2015, positive results validate this new model of rewarding doctors for quality care instead of quantity. Tandigm Health was able to lower costs and improve the quality of patient care across a region that truly requires disruptive change—the greater Philadelphia area.

In its first year, the proactive, high-quality care provided by Tandigm’s network of physicians reduced emergency room visits by 800, cut Medicare costs by 3%, and ultimately reduced healthcare costs in the Philadelphia region by $15 million. Notably, the patient population cared for by Tandigm physicians grew in one year by 30,000 to a total of 100,000 patients and the number of participating physicians was expanded from 270 to 380. While there is still much work to be done in a challenging and uncertain environment, these results demonstrate great promise for the value-based model—in Philadelphia and beyond. The initial success we’ve seen proves the positive impact that proactive primary care can have on a patient population.

Partnerships and innovation

Collaborative partnerships are key to success in any industry, but imperative for the evolution of healthcare. Partnering with like-minded local hospitals and physicians is essential to further expand and develop the value-based model. In 2015, we announced agreements with Holy Redeemer/Innovative Wellness Alliance and Doylestown Healthcare Partnership, growing our footprint locally and extending this new model of care to these leading-edge providers.

There is also great value in investing in new and innovative technology, tools and resources for physicians, to actively improve access, engagement, and health management for their patients. Physicians armed with these tools are able to then receive the right information at the right time in the right format to provide the finest patient care possible. Specifically, we enable our physicians with population management tools, which assist PCPs in identifying and managing patient’s conditions to prevent small problems from becoming larger ones. We’ve also recently expanded our partnership with telemedicine app TouchCare, allowing all 380 Tandigm physicians the ability to securely communicate with patients face-to-face using a mobile device.

Next: PCPs: the key to success

Engage, enable, empower

We attribute our success to a simple, yet powerful concept which focuses on engaging, enabling and empowering the network of PCPs; engaging our physicians with meaningful incentives to deliver high-quality care, enabling them with new and relevant technologies, and empowering them with people, programs and facilities to build a solid delivery system.

As a result of the quality care provided in year one, we were able to pay the Tandigm physician network more than $20 million in incentives above their base compensation. Of this $20 million, $8 million provides month-to-month support of Tandigm physician practices, enabling them to employ extra staff, offer extended hours, and provide resources to enhance patient care. The additional $12 million was earned by the physicians as a result of delivering proactive, coordinated, high-quality care. We place value on high-quality incentives, similar to the value we place on high-quality care.

Doctors and practices are empowered through the implementation of programs that improve patient access and engagement. For example, patients have greater access to care when clinical and administrative resources are made readily available to support physician practices and their patients. In 2015 a program was launched that allows nurses to meet with patients in the physician’s office to offer resources and educational materials and further enhance patient care. 

Results in year one prove that this model can positively disrupt the Philadelphia market and achieve meaningful outcomes. We’ve only just scratched the surface of the issues to be solved, but we’re making strides forward every day. It can be done. We can turn the future of healthcare in this country around, one small step at a time. And the solution does more than just lower costs—it creates a healthier, more vibrant ecosystem of healthcare where patient wellness is truly the priority.

Anthony V. Coletta, MD, MBA, is the president and chief executive officer of Tandigm Health, a value-based healthcare company working in tandem with primary care physicians to create a new paradigm of high-quality, affordable health care in the Philadelphia region.