Doctors have been trying to figure out the future of their industry since the Affordable Care Act was passed in 2010. They may have been better off looking for the answer in the past.
Dr. John Tedeschi founded the Marlton-based medical practice Advocare in 1998 for one reason: "To make doctors happy being doctors again and take away the things that are bothering them so they can get back to their patients and be as successful as they can possibly be," he said.
Since its founding, Advocare has grown to include more than 500 physicians across the state, using the scale to bring efficiency to the business side of medicine — thus becoming a model company for Obamacare.
And a perfect landing spot for doctors who know they will struggle if they continue in a small practice but don't want to join a hospital.
"Right now, doctors are very uncertain as to where their futures are," Tedeschi said. "A lot of them do not want to sell to hospitals. We feel health care is going to change their lives significantly in the next two or three years, and we're hoping to be prepared for that."
The Affordable Care Act is accelerating the drive to clamp down on the rising cost of health care.
The ACA authorized Medicare to create Accountable Care Organizations, where physicians and hospitals share the dollars that Medicare saves if providers deliver quality medical care that is efficient and avoids unnecessary hospital admissions. Commercial insurers have developed value-based reimbursement models that reward health care providers if they deliver quality care that saves money.
Advocare has created a Medicare ACO, and it provides population health management and care coordination services to its physicians.
"Since starting this group, I don't think anything has excited me more," Tedeschi said. "This prepares doctors for the future, and the impact on patient care is absolutely amazing."
Tedeschi said the practice has specially trained care coordinators armed with data to identify gaps in care.
"For instance, how many patients in the practice have not had their colonoscopy or their mammograms?" he said. "We have made huge strides in our care of diseases and in decreasing readmissions."
Care coordinators make sure patients get appointments with their doctors, and "we make sure you can get your medicines, you can afford your medicines, and you are taking your medicines," he said.
Clearly it's working.
Tedeschi said his "proudest statistic" is that, in 16 years, none of Advocare's physicians has left the practice. Maybe it's because Advocare is about more than just helping doctors with their patients.
Advocare's sister company, Continuum Health Alliance, provides practice management services to Advocare and other group practices around the state. These services include electronic medical records, risk management programs to lower malpractice rates, human resources, billing and bulk purchasing.
Right now, Advocare shares in the savings it achieves for health care payers but is not yet taking financial risks.
"But this will lead eventually to risk-based contracts, where our payments will be dependent on the performance and the quality of the medicine we are providing," Tedeschi said.
The majority of Advocare doctors are in primary care with about a quarter in other specialties. The group, however, is continually growing.
In January, one of the state's largest surgical practices, South Jersey's 19-surgeon Surgical Specialists of New Jersey, joined Advocare.
Dr. Christopher J. Boynton said it was an easy decision.
Boynton said his administrative costs will increase slightly with Advocare, but those expenses would have increased anyway just to keep up with government regulations.
"There will be less headaches for us to deal with because Advocare has a much more robust administrative team to take care of the things that need to be handled," he said.
Adovcare's technology infrastructure and care coordinators who monitor patient health impressed Boynton.
"(Advocare) has positioned themselves very well for the future," he said.
And did it with a vision Tedeschi had in the past.
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