News Feature | April 14, 2014

Provider, Insurer Create New Business Model

Christine Kern

By Christine Kern, contributing writer

Provider, Insurer Model

IBX and DaVita collaborate with new business model called Tandigm Health

The pressures of the ACA to reduce healthcare costs while increasing efficiency and quality of care has caused some practices to experiment with new business models to achieve better results. One example is the partnering of Independence Blue Cross (IBX) and DaVita’s physician practice to launch a new business called Tandigm Health.

This new venture will create a network of PCPs who will get higher reimbursement in return for reducing chronic conditions costs by finding ways to keep those patients out of the hospital.

In a press release, the partners announced the creation of Tandigm Health, “A unique joint venture that will help deliver high-quality, affordable care to the Philadelphia region by combining the expertise of one of the country's largest, most innovative Blue insurers and a nationally recognized pioneer of physician centric care – Independence Blue Cross and HealthCare Partners.”

Among the chronic conditions to be treated by the PCPs are diabetes, congestive heart failure, and pulmonary disease. Led by IBX SVP Anthony Coletta, Tandigm Health will provide doctors in the Philadelphia area with analytical tools and access to real-time data to aid patients in managing their condition and provide monitoring tools to help patients stay out of the hospital and in their own homes.

The goal of the new model is simple: offer a range of services to further enhance the delivery of patient care outside the physician's office in order to reduce duplicate services, improve patient satisfaction, and help prevent health crises that can drive up costs through emergency room visits.

Doctors in the network will receive a portion of member premiums as incentive. The idea is to better equip primary care doctors and hospital systems to make decisions about patient care, reducing duplicate services and improving patient satisfaction. Though it sounds similar to an Accountable Care Organization, a spokeswoman for IBX emphasized that it is unique.

Philadelphia has some of the nation’s highest healthcare costs. According to data from Milliman, hospital admissions in the Philadelphia region for people under 65 are the nation’s highest. If this experiment proves successful, it could provide a working model for healthcare providers across the country.