Dr. Amar Mohan, MD, founder and CEO of Transitional Care Physicians of America (TCPA), has built a unique practice that provides high-touch primary care to elderly patients with complex conditions in nursing homes and assisted living facilities. In this interview, Dr. Mohan discusses his journey from hospitalist to primary care physician (PCP), some of the challenges and rewards he experiences in delivering value-based care, and the culture of innovation he has built at TCPA.
1. When did you found your practice and how has it grown and evolved over the years? Why did you go into medicine?
My father was a physician in a rural community. Growing up, I saw the impact he had on his patients and families and always wanted to follow in his footsteps. When I finished my medical residency, I initially worked as a hospitalist. In so many cases, I’d see complex, elderly patients who were in the hospital for reasons that felt like they could have been prevented. It was never anyone’s fault, but the problem was a system that didn’t value time with patients and so things that should have been caught were not. For me that was a turning point. I decided to stop seeing patients in the hospital, and instead in nursing homes and assisted living facilities, where problems could be identified earlier and prevented.
2. What do you love about being a primary care physician?
I love the relationships I develop with my patients and the impact I can have. The complexities of my patients are truly what fascinate me as even though two patients may have the same diagnoses, they may be completely different given their personal, cultural and religious preferences. Talking to my patients and getting to know them beyond their disease is truly the most rewarding experience and the stories and knowledge our elderly have to share is truly humbling.
3. What are some of the core values that you try to bring to work every day as a primary care physician?
Our team is focused on delivering the highest quality of care through a team-based approach that enables our board-certified providers to practice effectively and efficiently, at the top of license. Building a new model of care, as we have done, requires curiosity, persistence, and teamwork — values that I bring to work every day as a primary care physician.
4. How would you describe the culture that you’ve built at your practice?
As I mentioned, our practice is unique in several ways. We don’t simply bring care to patients, but we actually embed our providers in facilities. When the provider goes from being a “provider” to a member of the team, some really special things happen — the threshold for asking questions goes down and you can catch things earlier. Additionally, we leverage a technology platform to streamline communication. One of the pain points our facility partners and families often have is that it’s hard to track down the provider or know what is happening. We leverage technology to streamline that process.
5. What are you most proud of in how you have built your practice and relationships with your patients?
I’m proud of how much we have scaled the high-touch model of care that I started years ago. Today, we’re one of the largest provider groups in Georgia caring for greater than 3,500 complex, elderly patients, with over 60 providers and more than 80 facility partners.
6. What are some of the challenges that you face as a primary care physician? How do you work to overcome those challenges?
Being a primary care provider is hard. At TCPA, we’re big believers in leveraging an interdisciplinary care team and technology to enable providers to focus on what they do best — caring for people. We leverage MAs, nurses, and care coordinators to do some of the things we don’t do well — data gathering, counseling, and coordinating care.
7. What does value-based care mean to you? And what do you think value based care means/enables for your patients?
For me, value based care means we’re simply doing our jobs and providers are rewarded for providing the best care to people. Ultimately value-based care leads higher quality of care at a lower price. For my patients, value-based care means access to resources and people they might not otherwise have. In a purely fee for service practice, you can’t simply embed providers in facilities or invest the time that is needed to prevent illness.
8. What was it that made you want to transition to value-based care models? What appeals to you about Medicare’s ACO REACH model (e.g. autonomy in how you deliver care to patients, capturing value from risk, capitation)?
We’re at the cusp of a big shift in how we pay for healthcare. The old model of fee-for-service isn’t sustainable financially. More importantly, it doesn’t deliver the kind of clinical results we need. As I mentioned before, value-based care can help pay for the things that we know work to improve outcomes and deliver a better patient experience.
9. What excites you about your partnership with Pearl Health?
I’m excited by Pearl’s knowledge of how to deliver value-based care at scale. With their knowledge and our scale, I’m sure we’ll make an even greater impact on our patients’ lives.
About TCPA
Transitional Care Physicians of America (TCPA) partners with leading skilled nursing facilities and assisted living facilities to improve healthcare transitions and long-term care. TCPA’s unique, team-based care model complements primary care, maximizes care coordination, and enables early identification and response to healthcare risks. Our approach improves clinical outcomes, reduces healthcare costs, and enables our providers to develop meaningful personal relationships with their patients and focus on proactive, whole person care.
Learn more at www.tcpamd.org.
About Pearl Health
Pearl Health is powering the future of healthcare. Led by provider enablement, risk-bearing, and technology experts, Pearl offers software and services that help providers reimagine how they visualize, understand, and care for their patients. Pearl supports primary care organizations and providers in their transition to value-based care and surfaces data and insights that help them deliver better, more proactive care, decrease total cost of care across patient panels, and optimize performance in risk-bearing models like Medicare’s ACO REACH. Since its founding in 2020, Pearl has raised approximately $100M in funding from investors such as Andreessen Horowitz, Viking Global Investors, AlleyCorp and SV Angel, and has grown to serve providers across the United States.
Learn more at www.pearlhealth.com.