Tandigm helps deliver better care, lower costs

Tandigm Health, a West Conshohocken start-up designed to help primary-care doctors manage costs and improve care in Southeastern Pennsylvania, said Friday that it cut health-care expenditures by $15 million last year.

Most of the savings - which totaled $3 million more than hoped for - came in the Medicare Advantage side of the business, which covers about 25,000 patients, Tandigm president and chief executive Anthony Coletta said.

"We dropped our Medicare Advantage spend by 3 percent, which is a big thing in the Philadelphia market," said Coletta, who is also an executive at Independence Blue Cross, one of Tandigm's owners. The other is Davita HealthCare Partners Inc.

Among Tandigm's successes, achieved by working more closely with patients, was a reduction in the number of emergency room visits by 800, or 16 percent, Coletta said.

In addition to the Medicare Advantage patients, Tandigm, which started operating on Jan. 1, 2015, also includes 75,000 patients in commercial health management organizations.

Savings in that arena are harder to achieve, because costs are concentrated in short-term, acute episodes, rather than in chronic conditions, which offer easier options for trimming costs, he said.

Kim Kuhar, who has a small practice in Bucks County, near Perkasie, welcomed the creation of Tandigm and said it is helping her improve patient care.

"It has required us as a practice to gear up and think a little bit different than we as physicians have traditionally thought," said Kuhar, who has another part-time doctor and a nurse practitioner in her practice.

"Now we have to start thinking about population health, how do we manage populations," she said.

To help doctors provide proactive and highly coordinated care, Independence and Davita spent $15 million setting up Tandigm since April 2014.

Tandigm employs close to 90 people, and Coletta hopes to expand to 175 by the end of next year.

Nearly 400 of the region's roughly 2,500 primary-care physicians have signed for Tandigm, which has focused on the 1,200 to 1,300 who are independent, Coletta said.

Doctors do not become Tandigm employees, but their patients who are enrolled in Independence HMOs or Independence Medicare Advantage plans become part of the group overseen by Tandigm.

Each month, Independence sends Tandigm the money it expects that pool of patients to cost, after subtracting a portion to cover its operations.

Tandigm assumes the full risk of paying health-care bills for the patients attributed to it. Tandigm's contract with Independence runs through 2019.

To compensate doctors for the extra work of closely tracking patients, as required under the Tandigm model, Coletta said that Tandigm increases the doctors' monthly payment per patient - known as the capitation rate - by 50 percent for commercial HMO patients and more than 50 percent for Medicare Advantage patients.

That increase was $8 million in aggregate last year for Tandigm doctors.

Barry P. Green, of Green & Seidner Family Practice Associates in Lansdale, said his practice has three people dedicated to managing patient care, a process that Tandigm has made more sophisticated.

"The enhanced capitation more than covers that cost and adds a financial incentive to really work hard at it," Green said.

Tandigm doctors are also eligible for bonuses based on quality and cost. In aggregate they earned $12 million of the potential $20 million in bonuses.

Coletta said Tandigm intends to continue expanding its network of primary care physicians, but it is also in discussions with specialists about a shared savings program that, for example, would reward specialists for performing surgery at lower-cost venues.

Another big effort is expanding patient outreach beyond the telephone calls relied on last year.

"That doesn't do nearly enough in terms of engaging patients and getting them the care that they need," Coletta said.

Tandigm is adding doctors, nurse practitioners, physician assistants, and others to work in the field with patients with complex health-care needs.

"It's hard for individual practices to provide for these more complicated patients, we're going to start to do that," he said.

hbrubaker@phillynews.com

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@InqBrubaker