Allegheny Medical Mall has range of related services housed under one roof

Neal Fanelli is pleasantly surprised that an idea he came up with 15 years ago is suddenly getting traction in western Pennsylvania.

Fanelli recruited a group of doctors and other health care professionals to provide complementary services, from urgent care to family practice, nutrition counseling, rehabilitation, chiropractic and, most recently, sports medicine. The idea was to coordinate medical care within one practice, breaking down the silos that have driven up costs while hurting outcomes.

What Fanelli came up with was an advancement of the patient-centered medical home years before the term was coined. And because all the services were provided under one roof, he called his Coraopolis-based practice Allegheny Medical Mall.

“We’ve been able to do something no one could do,” said Fanelli, 53, a chiropractor. “The model is designed for wellness, not sickness.”

But that’s where the similarity to the medical malls popping up around the region ends. The care at Allegheny Medical Mall is better coordinated because one practice provides the care, rather than a group of doctors leasing space in the same building, he said.

“They don’t know how to integrate,” he said about the other medical malls. “They confuse convenience with effectiveness. You put in an integrated model, and you drop the cost.”

That doesn’t mean the other guys haven’t been curious about Fanelli’s clinic. A big health insurer and hospital network — neither of which Fanelli wanted to publicly identify — have visited in recent months with questions.

Health insurer Highmark Inc., Excela Health and Heritage Valley Health System are developing medical malls, which house a group of medical services under one roof. However, unlike Allegheny Medical, these doctors generally don’t sit down at the same table to discuss treatment and progress of an individual patient.

The University of Pittsburgh Medical Center is among the outfits that have been aggressively transforming primary care practices into the team approach that the patient-centered model requires. A recent UPMC study found the return on investment for such a switch was 160 percent.

The patient-centered model uses nurse practitioners and other so-called physician extenders to coordinate and manage patient services, which results in lower costs and fewer unnecessary hospitalizations.

The shift is important because Medicare is preparing to pay doctors and hospitals a capitated or bundled rate for a group of services, rather than piecemeal for individual procedures. But Allegheny Medical Mall takes the concept a step further by integrating services in a single practice.

Doctors accustomed to performing a high volume of tests and procedures to maintain salary generally don’t adapt well to patient-centered care, according to Dr. James Costlow, an internist at Monroeville-based Premier Medical Associates, a large multispecialty practice and a pioneer in patient-centered medical homes. Premier has been able to achieve significant improvement in the care provided while holding down costs.

“It’s staggering how we compare to the network average,” Costlow said. “All of our data is from insurance companies, so it’s proprietary, but our numbers distinguish our group from the rest of western Pennsylvania.”