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.”
“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.
> “Clinically, we’ve been able to reduce length of stay by almost a full day on average,” Orel says, “and the EHR has helped us document that improvement for payers.”
> Advocare’s physicians have also been busy tracking a broad range of metrics across their organization, including success in ensuring appropriate cancer screenings, colonoscopies, and other preventive care interventions, and being able to analyze those metrics.
> With an additional lab interface to the EHR, patients’ routine lab test results are now appearing in patients’ electronic health records, often within the same day, compared to having taken a few days in the past.
Asked why things have gone as well as they have, Coyne says, “I think there are two major reasons why we’ve been successful with this. One, you can’t look at [an EHR rollout] as implementing software; it’s really a change management project. You’re changing the very nature of the way a physician does business. And if you approach this simply as an IT implementation, you’re doomed to fail, because there is a whole psychological aspect to this, including a lot of handholding. The second is that we took the base product that GE sells and enhanced it to meet our physicians’ needs. We created seven committees, of which had doctor participants. We essentially tried to make the doctors feel that this was their product, with which we were assisting.”
In addition, Coyne says, “The third thing is that you need a team of great people—a group that’s willing to work hand in hand with the doctors; it’s not always an easy task, because change is difficult. But if you get a great team of people who are dedicated to this, you’ll be successful.”
Asked what their advice would be for CIOs, CMIOs, and other executive leaders in physician groups and integrated systems would be, both gentlemen have thoughts. Coyne says, “What’s important is to really form a partnership between the technologists and the physicians; that’s critical. And in our case,” he adds, “to look for a vendor who’s more than a vendor, but instead a strategic partner who we feel will be in this for the long term. Nobody has a crystal ball, but we felt that GE, with its size and resources, would be a player for the long term.”
Says Orel, “I’ve been a practicing physician for 25 years, and have gone through many changes. But this is the first one that has really affected me at a personal level. This doesn’t just change how a physician documents an encounter; it changes the whole way a physician practices. For example, Joe set up an ergonomic room with 15 different options for physical interactions. And that was crucial. Some people want to sit with the patient with an iPad or laptop; others want to sit behind a desk, but then you have to incorporate that desk into the interaction.” It’s that level of interaction and partnership that needs to take place in a broader sense as well, he says, in order for this constellation of relationships—medical group, MSO-type support organization, and vendor partner—to really work over the long term.