Partners In Care, a physician-owned organization founded 18 years ago, works with doctors to coordinate the care their patients receive, with the goal of both improving health and avoiding wasteful spending. That mission is squarely in line with national health care reform, so PIC Chief Executive Ralph Tang sees plenty of growth opportunities in the years ahead.
"We are in a very unique position to truly address health care reform from a variety of angles," said Tang, who joined the East Brunswick-based PIC earlier this year.
Tang previously served in the national Patient-Centered Primary Care Collaborative, which pioneered the "patient-centered medical home" — a primary care practice that strives to improve population health.
A big part of PIC's work involves helping physician practices become more efficient and more effective. As the 2010 Affordable Care Act strives to reduce the national health care bill, Tang expects demand for that work to rise.
"We have a lot of physicians in New Jersey who are overwhelmed, concerned and confused about health care reform," Tang said. "They are trying to figure out how to leverage the opportunities or perhaps face the threats of the changes to their practices."
Tang said his goal is simple.
"Our mission is to deliver better health, better care and lower costs (by helping providers) to be patient-centered and therefore enhance the relationship between the provider and the patient," he said.
Tang said the massive uncertainty unleashed by the ACA is having a huge impact.
"A lot of providers are either selling out to hospitals or they are shutting down their practices," he said. "They are panicking. They are working longer hours and making less and trying to figure out how to adapt to the changes. At PIC, we believe we can help the providers to in fact thrive, as opposed to being scared about the changes in health care."
PIC coaches its members to adopt electronic medical records, something that Tang embraces. PIC is owned by its 420 member practices, about half primary care and half specialists, Tang said.
"We have a lot of smaller practices that are trying to get up to speed (on health IT)," he said.
The member practices don't pay fees to PIC. The organization's funding comes from the payers in the health care system: commercial insurers, self-insured employers and government health plans. The health plans compensate PIC, which in turn compensates the physicians for providing care coordination to make sure patients get routine preventive screening — mammograms, cholesterol tests, colonoscopies — and that those suffering from chronic conditions such as diabetes or hypertension get the medical care they need.
The payers are willing to pay extra for care coordination because when diseases are identified, treated and managed, they are less likely to result in high-cost medical crises — and hospital admissions — down the road.
PIC clients include the health insurers Aetna and Cigna and the health care services firm Integrity Health, which operates a "medical home" for the self-insured Toms River school district. Tang said he is in talks with the other major insurers and health plans in New Jersey.
This month, Middlesex County chose PIC to launch a pilot program aimed at both improving the health of the county's employees and reining in the costs. The pilot will involve 100 health plan members and, if successful, will be rolled out to the county's nearly 8,000 employees and dependents.
Tang said that PIC will review the medical claims data from the Middlesex County Joint Health Insurance Fund "and determine which patients need what kind of care and if there are any gaps in care. We will look at preventive care and at those who have been identified with chronic diseases."
PIC will also identify patients overdue for a physical.
"For those who have not had wellness visits and who have conditions that may have become more serious, we will intervene and help make sure that they come back to see their physician," Tang said.
In announcing the partnership with PIC, Middlesex County Freeholder Director Ronald G. Rios said unsustainable health care costs are among the biggest challenges facing local governments across New Jersey. He said PIC "has an 18-year record of success in helping public sector and other self-insured employers lower health care costs while providing employees with better and more effective care."
Tang said PIC's success stories include a 15,000-member employee group that saved $3 for every dollar spent on PIC's services. For a municipality with 1,500 health plan members, PIC saved $2.20 for every dollar.
"We were practicing population health before it became a buzzword," Tang said. "We became pioneers in this area."
PIC has a staff of 20, most of them nurses and other clinicians who "do the analysis of clinical data about patients so they can collaborate with the physician's office to make sure the proper clinical care is provided," Tang said.
The PIC network of physicians grew 20 percent this year, and Tang sees that growth continuing. PIC is in 13 of the state's 21 counties, concentrated in central and southern Jersey, and Tang is looking to broaden the geographic coverage of the state.
Hospitals are acquiring physician practices statewide, and Tang said PIC "is talking to some hospital physician organizations about joining us."
He said one hospital physician network has joined PIC so far, and PIC will continue to work with the state's many small physician practices as they grapple with health care reform.
"We are well-equipped to support and help small practices really thrive in this environment through the services, the technology and the support we provide," Tang said. "Small providers are concerned about shutting their doors because of all these new regulations. We reach out to them with a message of hope."
E-mail to: firstname.lastname@example.org
On Twitter: @bethfitzgerald8