Insurance-led effort aims to better manage patient health through primary care offices

Nearly 300 primary care doctors have joined an insurance-led initiative aimed at reducing costs and improving patient health.

Achieving those dual objectives has been the puzzling crux of many government and private sector efforts in recent years, ranging from designated medical homes to Medicare-backed accountable care organizations.

The idea of Tandigm Health, formed by Independence Blue Cross (IBC) and Davita HealthCare Partners, Inc., is to give doctors more tools to manage patients both inside and outside the exam room.

Participating doctors are already part of IBC’s HMO network, meaning they receive a set monthly payment for patients. Though Tandigm CEO Anthony Coletta wouldn’t give specifics, the new initiative would boost those payments and offer additional financial incentives for achieving certain outcomes and benchmarks.

Primary care doctor as the hub

Think of primary care doctors as the quarterbacks of the health system. In theory, they’re the ones best positioned to call the shots, making referrals to specialists, and managing patients’ overall care. But Dr. Barry Green, a family doctor and head of Renaissance Health Network in Wayne, Pennsylvania, says what traditionally happens is as a doctor “I take care of my patient when they come in, I talk to them about what needs to be talked about, I do their labs and then I see them again in whatever time frame is appropriate, call it three months, four months, six months.”

Green says that approach has a lot of blind spots for managing patient care. What happens to patients and their level of disease management outside the exam room? What’s happening at the specialist office? Overall, it’s a fragmented system, he says, and doctors typically lack the resources to effectively monitor patients’ health at the population level and prevent potential complications.

It all contributes to unnecessary hospitalizations and higher health care costs, which Coletta points out Philadelphia has more of compared to other large metro areas. He says addressing that dynamic is the driver behind Tandigm Health.

“With the right data and the right information and with the right resources and incentives, these primary care physicians can manage patients to a higher quality at a lower cost,” he said.

Coletta says they’ve recruited about 270 primary care doctors — about a quarter of those in independent practices in the region. However, the majority are from Green’s practice. Tandigm will provide infrastructure and technology to help participating doctors better manage patient health in real time, identifying pre-diabetic patients, for example, and help target interventions before problems surface. 

From the patients’ perspective, it may mean some will be hearing more from their doctor’s office.

Through claims data, Tandigm will also share data on specialists in the region to help inform primary care doctor referrals.

Robert Field, a professor of health law at Drexel University, says Tandigm’s success will depend on whether it can build out the effective technology and the right incentive structure that so many others in health care have failed to do.

“They’re putting a lot of stock in it, and I think one of the questions is do they have a system that’s up to the task?”

The initiative is scheduled to go live January first.

Disclosure: Independence Blue Cross is an underwriter for WHYY’s The Pulse.