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Horizon announces expansion to patient-centered care model

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To continue its push to transform primary care practices in New Jersey from a doctor-does-all model to team-based coordinated health care, Horizon Blue Cross Blue Shield of New Jersey has expanded its patient-centered medical home program to reach 154,000 members through 145 practice locations.

"We've more or less doubled the number of participating members and practices up to July, with the intention to add another 20 practices on November 1," said Jim Albano, vice president of health care services for Horizon. "I think it's important for us to continue to communicate that we are still focused on adding more to the program and we are still committed to the concept."

Horizon's patient-centered medical home program — which launched with eight practices in January 2011 — changed the traditional payment model between providers and insurers by rewarding primary-care physicians and nurses for improving a population's access to care, and coordinating ways to manage patients' chronic conditions over time.

While Dr. Alfred F. Tallia, chair of the Department of Family Medicine and Community Health at UMDNJ-Robert Wood Johnson Medical School, has been implementing similar concepts from his department's early research on the model, he noted Horizon has been "way out in front of all the insurers" in New Jersey to expand it, which is why 18 doctors in his teaching practice joined the program last month.

"Coordination and cooperation and communication between nurses, patients and doctors is incredibly difficult to do in a market that does not reward good outcomes in primary care," Tallia said. "We know from our own research that these models work, in terms of improving outcomes for patients and reducing costs, so to have an insurance company like Horizon take the lead and actually reform the payment system to promote the patient-centered medical home is a game changer."

According to Tallia, the most significant component of Horizon's program is the upfront funding it provides to doctors to adopt electronic medical records systems and hire nurses who received training in coordinating population care through the insurer's educational partnership with the Duke University School of Nursing and the Rutgers College of Nursing.

"When you implement a team-based population care management system, the evidence is that it improves patient health and costs go down, but it's still in its infancy because of the costs to do it all," Tallia said. "A lot of practices are hanging on by their thumbs financially, so it's a huge step forward for an insurance company to do that."

The upfront costs are high, but as Horizon provides financing for 48 practices to implement digital medical records and hire one population care coordinator for every 1,500 to 3,000 patients, Albano said he is seeing the return on investment, which he said makes the patient-centered medical home model "critical to our future success as an organization and our future success as a delivery system in New Jersey."

"We don't have formal timeline for reaching all of our members through this program, but we know we want to move in that direction," Albano said. "Our focus in 2012 has been on growing the number of practices participating in the program, and going into 2013, I think we'll look at a number of areas to expand, including anything other than family practices."

Though Horizon currently does not have the guidelines in place to expand its program to practices beyond primary care, Tallia said he will attempt to employ the insurer's patient-centered medical home concepts throughout the UMDNJ-Robert Wood Johnson Medical School, including specialized departments like obstetrics and gynecology.

"We're starting it in our family practice group, but I think we can apply it other parts of our medical group, as well," Tallia said. "The ability to participate in a fundamental transformation of primary care is essential for us to stay a leading-edge type of practice, and the work that Horizon is doing in our office has been at the cutting edge."

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