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'A champion' for business as search to curb care costs goes on

Doctor: 'We're at the easy part' of changing system

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Dr. Alfred Tallia's research at RWJ Medical School already is being felt as the patient-centered medical home concept begins to gain steam.'Al really helped shape the model,'says a clinical innovations expert at Horizon Blue Cross.
Dr. Alfred Tallia's research at RWJ Medical School already is being felt as the patient-centered medical home concept begins to gain steam.'Al really helped shape the model,'says a clinical innovations expert at Horizon Blue Cross. - (AARON HOUSTON)

For fifteen years, Dr. Alfred Tallia has studied patient-centered primary care at Robert Wood John- son Medical School, trying to find a solution for a health care system that the corporate community finds unsustainable.

"We've been asking for care that is managed efficiently and effectively," said Dr. Paul Grundy, global director of health care trans- formation for IBM.

For Tallia, chair of the family medicine department at RWJMS, the answer lies in the patient-centered model he has researched, implemented and measured — and executives are paying attention to his results.

"We have a champion, we have somebody on our side that under- stands that and wants the same thing, and knows that the system has to change to that," Grundy said. "We have an ally in the work that Al is doing."

Grundy and Tallia have worked together in the Patient-Centered Primary Care Collaborative, a national group of health care stake- holders — ranging from providers to payers to employers — working to get the patient-centered care model implemented more widely. And while both men understand the task of turning around health care delivery is monumental, Tallia could not be more thrilled to be in the eye of the storm.

"Now that there are all of these transformations that are occur- ring in payment, this is the easy part. Now there's actually money involved to reward what will put patients at the center of the health care system," Tallia said.

Patient-centered medical homes are primary-care practices that take responsibility for the total wellness of a population of patients. The model uses data and population care management to encourage preventative care. It also creates incentives to reduce overall costs while increasing quality.

Tallia's research at RWJMS into the model already has been translated into real-world success. The family care clinic at Monument Square, in New Brunswick, is a nationally certified PCMH that provides coordinated care to the community, as well as students and faculty at the university.

The work implemented at the Monument Square clinic was built off work Tallia did with Horizon Blue Cross Blue Shield of New Jersey, where he was brought on board as an adviser to the state's largest insurer as

it designed a PCMH model that could work outside the academic setting. The clinic is now part of Horizon's PCMH program.

"Al really helped to shape the model. He was someone that Horizon looked to for his understanding in what we should be striving toward around comprehensive, team-based care," said Dr. Steven R. Peskin, senior medical director of clinical innovations for Horizon. "By working with Dr. Tallia, and Dr. Tallia putting his weight behind and endorsing (the model), improves the receptivity of the audience."

"The Horizon piece really has accelerated our gearing up to get to the real meaning of a patient-centered medical home," Tallia said. "The fact that they were willing to listen, they were willing to then take the kinds of work that were going on in this department and in this school and turn it into a business plan ... has been a really good thing for the state."

Horizon's PCMH partners are starting to show results in reducing rehospitalization and lowering care costs for its participants. Currently, Horizon's PCMH practices are responsible for more than 154,000 patients around the state and early versions of the program saw a 10 percent lower cost per patient, per month.

Tallia was also instrumental to finding the best ways for Horizon to measure the success of the new practice models, in terms of both cost efficiency and quality metrics, which Tallia said fits with the RWJMS research mission.

As an instructor at RWJMS, Tallia also is educating the pipeline of upcoming physicians who will fill PCMH practices. Tallia says the cost and quality problems in New Jersey are directly related to the fact that there are very few primary-care physicians in the state, compared to population, and the school is trying to "really strongly in- crease interest in primary care to students."

"This is somebody who has taken his department and is beginning to ... create a pipeline of physicians, nurse practitioners and others that can deliver this level of care, and has been doing it now for four or five years," Grundy said. "He's more than just a good guy that gets it — he's a good guy that gets it and is delivering it."

Peskin said that, during his 15 years of academic privilege at Robert Wood John- son before joining Horizon, he heard col- leagues from other departments giving a lot of weight to Tallia's opinions.

"He's a leader among leaders," Peskin said, adding that RWJMS president Dr. Peter Amenta relies heavily on Tallia's opinion on health policy.

E-mail to: melindac@njbiz.com
On Twitter: @mcaliendo33

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