A major health insurer is giving New Jersey doctors more money to provide a holistic approach to care.
Aetna has launched a new Patient-Centered Medical Home program aimed at rewarding doctors who meet guidelines designed to improve patient health and reduce hospitalizations.
The program is being rolled out first in New Jersey and Connecticut, but will go nationwide by year’s end, according to Susan Millerick, an Aetna spokeswoman.
“The PCMH program is one more way we are moving from a system that rewards the quantity of procedures to a system that rewards quality outcomes,” said Elizabeth Curran, head of national network strategy and program development at the Hartford-based company.
Under the program, primary care doctors that have met the standards of the National Committee for Quality Assurance and aren’t participating in Aetna’s other quality incentive programs will get a quarterly “Coordination of Care” payment for each non-Medicare Aetna member they care for.
“It’s very straight-forward,” Millerick said. “We’re not asking them to do anything beyond what the NCQA recommendation indicates that they’re doing.”
The NCQA standards encourage doctors for providing services such as being reachable after normal business hours, proactively offering preventative screenings and sending out reminders about appointments.
Aetna has 1.2 million members in New Jersey, and Millerick said about 222 doctors have earned the recognition needed to participate in the program.
She said patients can see if their doctor is recognized as a Patient-Centered Medical Home by searching Aetna’s online provider directory.
Horizon Blue Cross Blue Shield New Jersey offshoot Horizon Healthcare Innovations has been operating PCMHs around the state for a year, and Cigna announced in December it will run an accountable care organization, a health system-wide attempt to control costs and increase quality, in New Brunswick.
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