Horizon nearly doubles size of patient-centered program

Costs drop by 10 percent and emergency room visits decrease by 26 percent

Horizon Blue Cross Blue Shield of New Jersey is nearly doubling its patient-centered medical home (PCMH) program in an effort to further spread the practice of team-based coordinated healthcare.

Newark-based Horizon's PCMH program, which rewards primary care providers for improving members' access to care and coordinating chronic care, now has 154,000 members participating, up from 80,000 when it started two years ago. It also boasts 48 primary care physician practices in 145 locations, reported the Philadelphia Inquirer.

Essentially, the PCMH helps "the primary-care doctor to focus on all the patients, not just the patients who come in" when they're sick, Jim Albano, vice president of Horizon's network management, told the Inquirer. Horizon pays doctors bonuses up to 40 percent of their income when they meet certain goals for quality, patient satisfaction and cost reduction.

Although Horizon's own upfront costs are high as it finances the implementation of electronic health records in all participating doctor practices and hires a population care coordinator for every 1,500 to 3,000 patients, the insurer says it's seeing a return on investment, NJBiz reported. In fact, the PCMH program has reduced costs by 10 percent and emergency room visits by 26 percent. And members in the PCMH program received cancer screenings more frequently and better controlled diabetes, the insurer said in a statement.

Horizon is planning to continue expanding its PCMH model, hoping to include up to 80 percent of its total 3.6 million members in a PCMH. Albano added that New Jersey's largest insurer may consider including providers beyond family practices in 2013.

To learn more:
- read the Philadelphia Inquirer article
- see the NJBiz article
- check out the Horizon statement

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