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Primary Care Innovations Based on Homegrown IT Systems

June 12, 2013
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JenCare CMO Craig Tanio says customized systems a key pillar of its approach to treating chronically ill patients

What if you could hire a team of software engineers to start from scratch in developing an IT system to fit the needs of your organization? Does that sound too good to be true? That is exactly what JenCare Neighborhood Medical Centers is doing. The privately held physician organization that started as ChenMed in Miami is branching out in a partnership with Humana to 35 centers in Florida, Virginia, Louisiana, Kentucky, Georgia and Illinois by the end of 2013. Its focus is Medicare Advantage patients with five chronic conditions.

I saw a great presentation June 12 at the Jefferson School of Population Health in Philadelphia by Craig Tanio, M.D., chief medical officer of JenCare. He talked about creating new care models focused on the needs of patients with multiple chronic conditions. Tanio noted that the capitated model of taking on full risk allows for significant innovation. For instance, in a fee-for-service model, an innovation like e-visits are done as a pilot, but the question becomes whether it is a substitute for a visit or additive, he said. “While questions about reimbursement are debated, the project spins and stalls. But in a fully capitated system, we don’t have to worry about that.”

Dr. Tanio is a great speaker with an impressive resume. He received his M.D. from the University of California San Francisco and his M.B.A. from the Wharton School at the University of Pennsylvania. He completed his residency and was Chief Medical Resident at the Hospital of the University of Pennsylvania followed by a fellowship in General Internal Medicine as a Robert Wood Johnson Foundation Clinical Scholar. He then practiced as an internist and served as the Chief Operating Officer of Baltimore Medical System, a group of federally qualified community health centers that focused on providing health care for the uninsured. Most recently he was a partner in McKinsey & Co., the management consulting firm, where he worked with national and international health systems to improve the quality and outcomes of health care.

Tanio’s presentation covered many aspects of innovation, but our readers will be most interested in what he said about information technology. He said that he sees one of the differentiators for JenCare is developing in-house technology and customizing it for a full-risk approach focused on chronically ill patients.

Most EHRs capture data to support documentation to justify fee-for-service billing, he said.  The JenCare system requires less documentation and allows physicians to make precise notes, providing efficiency gains, he said.

 “We are really in a different business that what the typical EMR offers, so we would have to recreate 80 percent a new system anyway,” he said. Traditional EMR systems tend to trap healthcare systems in being dependent on them, he added. The cost of IT development has dropped in the last decade, he claims. JenMed has hired 40 software engineers to develop apps.  The system they created can be accessed from iPad or smartphone. It is made up of customized widgets. Users can choose them like apps in the iTunes Store and rearrange the look and feel to fit their individual preferences. Having staff software engineers allows for rapid development of small ideas, such as a patient ID swipe card called a life card that contains the patient’s last EKG. “We can ask them to design an app and have it in six to eight weeks, do beta testing in one or two markets, and fine tune it,” Tanio said. “There is no technological reason not to do it this way, except that vendors make more money off a closed environment.”