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N.J. will be testing ground for new primary-care practice model

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The Centers for Medicare & Medicaid Services today selected 73 primary-care practices and five health insurers in New Jersey to participate in a new federal program aimed at incentivizing the creation of a patient-centered health system to improve access to primary care at lower costs.

“We asked what investment it would take to make our primary-care system the most innovative and comprehensive one in the world and to deliver more integrated care, and every corner voiced support for the public-private partnership,” Dr. Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation, said today during a conference call. “This initiative will support doctors and nurses by giving them the tools they need to deliver better care … and they will have the incentives and rewards to make it happen. We see great potential, as better health and better care lead to the better costs.”

Under the federal Comprehensive Primary Care Initiative, more than 2,000 doctors at 500 primary-care practices in seven regional markets will receive incentive payments from CMS — as well as additional incentive payments from participating insurers, which include Amerigroup, AmeriHealth New Jersey, Horizon Blue Cross Blue Shield of New Jersey, United Healthcare and Teamsters Multi-Employer Taft Hartley Funds for the New Jersey practices — for becoming more accessible to patients after office hours and implementing an electronic medical records system to coordinate and manage patient care.

At its launch, Gilfillan said the program will “serve 300,000 Medicare beneficiaries and hundreds of thousands of others with private insurance,” though physicians will only receive incentive payments from CMS for improving Medicare patients’ care, at an average rate of $20 per beneficiary each month.

 Over the next two years, CMS will measure the results of the program, and expand it nationwide if the practices provide data showing they have better managed care and costs, Gilfillan said.

Gilfillan said CMS wants to “make it as simple as possible for practices to change their staffing approach and the way they operate,” so in selecting practices for the program, the agency looked at their ability to hire care coordinators and adopt digital record-keeping systems.

That’s part of the reason why CMS selected 37 primary care practices in New Jersey currently participating in Horizon’s patient-centered medical home program, which provides incentive payments to doctors for monitoring patients’ long-term health, as well as the upfront funding to implement electronic records and hire nurses trained in population care coordination.

In a statement, Jim Albano, vice president of health care services for Horizon, said all 73 practices selected for the CPC Initiative’s New Jersey market may also have the opportunity to participate in the insurer’s patient-centered medical home program.

“With early results showing that Horizon’s collaborative medical home program is improving the quality of care and reducing health care costs, we want more of our members to benefit from the program,” Albano said in a statement, noting the company intends to grow its medical home and accountable-care programs to 200,000 Horizon members by the end of the year through its participation in the federal initiative.



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