Stephanie Celani not only knew the phone number of her patient John Pantalone, she also knew his weight to the half-pound when asked one day this month.
That’s because Celani, a registered nurse at Advocare L.L.C., a 380-member physicians group in Marlton, has been Pantalone’s care coordinator for the last five months, since he was laid low by a serious infection acquired at a rehabilitation hospital.
Celani calls Pantalone, 70, of Marlton, almost every day for information, such as his weight, blood pressure, and a figure that shows how his transplanted kidney is working. Celani reports any deviations to Pantalone’s doctor.
During the most intense period of Pantalone’s recovery, “Stephanie was becoming like a family member. She would call me every morning” and ask for the “magic number,” his weight, Pantalone said.
The purpose of all those calls is to keep Pantalone, whose health problems spiked in the fall when he had renal failure and collapsed lungs after heart surgery, from landing back in the hospital.
Pantalone is experiencing firsthand a push by
Advocare and Horizon Blue Cross Blue Shield of New Jersey – in accord with national efforts – to trim spending and improve quality by proactively approaching care, especially for high-risk patients.
Under the program, which Advocare started in August, the practice has a strong incentive to cut the total cost of care: Horizon lets Advocare keep half of any saving.
The program represents a major shift for doctors.
For a long time, physicians have known the costs of their own services, said John M. Tedeschi, a pediatrician and founder of Advocare, “but they never added the other piece.”
“What was I spending on hospitalizations? What was I spending on radiology? What was I spending on specialty referrals? What was I spending on five million other things that go into health-care costs? Now we’re going to have that whole picture,” Tedeschi said.
An early focus at Advocare, which has doctors in all of New Jersey and in Southeastern Pennsylvania and which is among the nation’s largest independent physicians groups, has been reducing the frequency of hospital readmission of its patients within 30 days of discharge, an area of health care under laser focus nationally now that hospitals are being penalized by Medicare for excess readmissions.
Advocare is not a hospital, but its Horizon contract gives it a financial incentive to reduce readmissions under the insurer’s most advanced shared-savings program, said Jim Albano, Horizon vice president of network management and Horizon health-care innovations.