John M. Tedeschi, M.D., a New Jersey pediatrician turned health care entrepreneur, admits he is “obsessed” with the ideals of the Affordable Care Act (the “ACA”): (1) increasing the quality of health care, (2) increasing patient access to and satisfaction with health care, and (3) decreasing the costs of health care. “Physicians love being physicians,” according to Dr. Tedeschi, but they are “miserable” because they dislike how much running the business-side of a medical practice results in less time spent with patients and making the ability to lead a balanced life more difficult. He has spent most of his professional life trying to mitigate these problems so that physicians would sustain their passion for being physicians.
Dr. Tedeschi first attempted to restore physician enthusiasm for the practice of medicine by forming the Southern New Jersey Pediatric Society, an entity with the twin goals of cutting down on expenses of operating a practice and educating the members on the business of understanding managed care. The formation of this entity began Dr. Tedeschi’s journey in working toward improving patient care while increasing physician satisfaction. In 1998, he implemented his model in a private practice setting by forming Children’s Health Associates (now called Advocare). What started as a 32 physician group practice has now grown into a multi-office practice with more than 400 physicians. He then formed Continuum Health Alliance, LLC (“Continuum”), as a vehicle for implementing his goals of quality patient care and physician career satisfaction.
Continuum, a health care management company, provides member physicians with what Dr. Tedeschi calls the “four pillars” of practice assistance: financial management, billing, information technology, and administrative services. As a result, Continuum strives to provide medical practices with a system in which patients will have more time with physicians and the physicians will have more time for themselves. The Continuum model also works to provide physicians with opportunities to deliver cost efficient health care, with the opportunity to enhance their compensation, and achieve all of this by also reducing the administrative headaches, expenses, time demands, and worries that comes from running a practice.
Dr. Tedeschi has recently added a fifth “pillar” to Continuum’s structure, “Population Care Management,” due to the evolution of the health care industry. The shift toward specialized medicine has created a need for population care management, which Dr. Tedeschi believes is the future of medicine and the appropriate model to implement the ideals of the ACA.
The efficacy of population care management is best explained by examining the issues raised in the following examples:
Example 1: Four specialists independently examine a hospitalized patient and are asked to diagnose the patient’s problem and treat it. A cardiologist examined the heart and said that the patient may have a blockage and would need a catheterization; a nephrologist examined the kidneys, found kidney failure and said the patient would need a kidney transplant; a pulmonologist examined the lungs, said the patient had COPD and would need an inhaled steroid; and an internist found that the patient had high blood pressure and prescribed an intense exercise program. All the specialists were correct, but the treatment for any one problem could cause serious injury or death as a result of another problem where there is no communication between the treating physicians.
Example 2: Even more problematic is the situation of a high-risk patient. A high risk patient and a patient’s family are rarely able to coordinate the multiple levels of care required, or understand the ramifications of one treatment versus another. Often, these patients fail to follow discharge instructions, take correct medicine dosages, adhere to recommended diets, or schedule follow up appointments with their specialists within a short time after discharge from the hospital.
Dr. Tedeschi views the population care management model as the solution to these problems. The population care management model teams physicians with insurance companies in managing the care of the whole patient. Nurses, pharmacists, and social workers provide the connections among the patients, the hospitals, and the physicians through regular follow up and communication on behalf of high-risk patients after their discharge from a participating hospital.
Continuum’s business model provides an example of the advantages of the population care management model in real-life practice. Continuum employees check-in with approximately thirty New Jersey hospitals in the network to ensure that no high-risk patients of their physician clients leave the hospitals without Continuum’s knowledge. Starting with discharge instructions, Continuum is heavily involved in coordinating the patient’s continuing care as directed by the physicians by ensuring that the physicians’ instructions make sense, can be followed by the patient, and do not conflict among the different specialists treating the patient. Continuum employees also check in with the patient and the patient’s family within the 48 hours immediately following discharge to make sure all is well and assists with coordination of care. They ask the patients if they are taking their medicines in the correct dosage at the correct times, and they intervene if the patient cannot afford to pay for the medication. The employees also check in with the patient’s physicians and coordinate the care so that what one physician may prescribe for the patient is safe in the context of other physicians’ treatment regimens. If a patient must see a physician, Continuum, which is given access by their client physicians to their schedules, can quickly get the patient in to see the physician. This coordinated effort allows physicians to focus on doing what they do best, providing continuing, high quality patient care, while still making sure that the whole patient is treated.
Dr. Tedeschi has also expanded the population care management model to assist and support individuals with certain high-risk chronic conditions that can best be monitored and treated by effective care managers working with the patient on everything from making sure that the patient timely renews prescriptions and faithfully takes them according to the physician’s instructions to scheduling physician and testing appointments. As Dr. Tedeschi says, what is best for the patient is also best for achieving cost efficiencies in the delivery of health care and reducing hospital stays.
Dr. Tedeschi’s population care management model is an outgrowth of his mantra “quality breeds success.” This means that effectively and consistently monitoring a patient’s overall health will result in better quality lives that are lived longer without hospitalization. The population care management model also increases physician satisfaction, restoring what Dr. Tedeschi sees as a waning zeal for the practice of medicine as a result of the business-side of medicine. He believes that this is the future of medicine, and even without the new federal health care law; he knows that it is the right approach to maximize the benefits to patients, providers, and payors alike.