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Innovating on IT Services Strategy in a Medical Network

March 3, 2012
by Mark Hagland
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How one New Jersey physician group built a self-supporting IT services company to meet its EHR and revenue cycle needs

What happens when strategy, collaboration, and necessity all meet? Sometimes, one gets noteworthy innovation, along with unusual, yet very workable, organizational structures. That’s certainly what’s happened in south central New Jersey, where an initial collaboration of private-practice physicians has led to both a physician organization with a highly entrepreneurial culture, and a spinoff IT and administrative services organization that now services the IT needs of several different area patient care organizations.

The story goes back to 1998, to when a number of south Jersey medical groups came together in what was first called Children’s Health Associates, and which in 2007 changed its name to Advocare, LLC. The Marlton, N.J.-based group’s first leader was John M. Tedeschi, M.D., a well-known area pediatrician, and the group began as a pediatric group practice, explains Howard Orel, M.D., the group’s co-founder (along with Dr. Tedeschi) and executive vice president of finance. The group began with 33 pediatricians in 10 practices, and since then, has expanded to include adult internal medicine and family medicine doctors. The multispecialty group practice now known as Advocare encompasses 300 physicians and between 50 and 60 physician extenders, for a total of about 370 medical providers in over 70 locations throughout the state of New Jersey and south central Pennsylvania, including five locations in the Philadelphia area, Dr. Orel reports.

With regard to the first seeds of IT and organizational innovation, Orel explains that, “From the early days, “Dr. Tedeschi stressed the importance of our owning our own data: data is king. We wanted to be able to house and manage our own data with regard to clinical quality outcomes, the cost of healthcare, and then much more detailed data such as hospitalization rates and ER utilization rates, and we did not have an EHR [electronic health record] initially. But as the group came together,” Orel notes, what emerged organically out of early strategic discussions was the need for a medical services organization (MSO) that could provide the range of management services to the group’s busy physicians.

Howard Orel, M.D.

Thus was born Continuum Health Alliance, which Orel describes as “our homegrown management company,” and which provides “technology services, financial services, including revenue cycle management, and administrative services. We’ve kept it as a separate organization to create some appropriate legal boundaries and administrative flexibility,” he adds.

In fact, Continuum Health Alliance’s success in servicing the needs of its founding organization has been such that, while it continues to provide Advocare with all its MSO services, CHA also provides MSO services to “five or six” other regional physician networks at present, Orel explains.

Still, even at its present size, with about 60 IT employees, under the direction of senior vice president and CIO Joe Coyne, CHA devotes about 70 percent of its work to supporting Advocare’s IT and other management needs, Coyne and Orel confirm.

The symbiosis between the two organizations continues moving forward, with the organization’s EHR (GE Centricity EMR), being implemented beginning in 2010, following the 2009 implementation of its revenue cycle solution (GE Centricity Business). “We’ve been rolling out the EHR throughout our offices over time,” Coyne reports. “We’re about 60 percent completed with Advocare as of 2012,” he notes, “but that number is a moving target, because we also keep adding practices to Advocare.”

Joe Coyne

“It’s important to fully understand the relationship between Advocare and CHA,” Orel emphasizes. “While CHA has many clients, Advocare has only one MSO, CHA. So we have the advantage of having national-level people like Joe Coyne and his team; and that ability to put minds together in a room has really provided advantages to us. We’ve had tremendous confidence in our MSO team,” he testifies, “we looked to them for EHR, and they found a solution.” What’s more, he explains, “Joe and his team were charged with going out and getting the very best product they could for Advocare; and we pay a management fee from Advocare to Continuum that provides us with all the solutions we need.” Meanwhile, CHA’s growth, including its expansion to support the IT needs of other area medical groups and networks, in turn enriches Advocare’s IT experience, as CHA continues to learn and grow, and to share what its team has learned with all of its customers, including Advocare.

The result is fairly straightforward. Asked whether Advocare’s physicians have been happy with the service they’ve received from their symbiotic tech partner, Orel says, “We have been, we’ve been very pleased. And between GE’s handling Continuum as a client and Continuum’s handling us as a client, we’ve been very happy.”

Among the gains that have been made since the first phase of the ongoing EHR rollout, Orel says, are the following:

> Coding and compliance reviews are now done from Advocare’s central business office, using the EHR system, and such reviews are “much easier, more effective, and less time-consuming now” when done leveraging automation.