Summit Medical Group, the state's largest medical practice with more than 300 doctors in 20 locations serving 160,000 patients, announced Monday it will join the network of the state's largest insurer, Horizon Blue Cross Blue Shield of New Jersey — one of several partnership Summit has forged in an attempt to improve patient outcomes and rein in medical costs.
"Horizon is committed to working with health care leaders like Summit Medical Group to transform the delivery of health care to enhance the patient experience, improve clinical outcomes, and reduce unnecessary health costs for our members," said Jim Albano, vice president of network management for Horizon Healthcare Innovations. "We welcome Summit Medical Group to our physician networks and look forward to a strong and innovative collaboration."
Last month, Summit and the health insurer Cigna launched a new program that also provides Summit with financial incentives to coordinate and improve patient health.
Dr. Jeffrey LeBenger, chief executive of Summit Medical Group, said the practice has leveraged its size, its diverse community of primary care doctors and specialists, and its electronic medical record system to zero in on improving the health of its entire patient population — rather than simply treating individuals who show up with symptoms and ailments. With electronic patient records, Summit can create registries, for example, of all patients with diabetes or congestive heart failure, and then work on improving the care of patients whose chronic conditions need to be controlled.
"There are a lot of medical issues that we can follow behind the scenes, looking at the total population — we are big enough to be able to do that," LeBenger said.
LeBenger estimated Summit could gain about 22,000 new patients this year as a result of the Horizon agreement, and about 60,000 over the next three years.
At its Berkeley Heights headquarters, Summit's urgent care center functions like a small emergency room, and Summit patients are encouraged to use the center rather than the local hospital ER. The result, LeBenger said, is that only about 2 percent of Summit's urgent care patients are admitted to hospitals — far less than the number of hospital ER patients who get admitted.
LeBenger said Summit left the Horizon network about seven years ago over reimbursement issues.
"We have been in discussions with them over the years, and just over the past year, we have been talking to them earnestly about trying to get a contract going," LeBenger said. He said the wave of the future is toward health care providers being compensated based on patient outcomes and cost.
"Medicine is changing slowly from fee-for-service to controlling population health, and we are ahead of the curve by trying to control the costs of medicine," LeBenger said. Under the Horizon contract, "when we decrease our utilization, there is a shared savings, and we participate in that shared savings," he said.
Christine Stearns, vice president for legal and health affairs at the New Jersey Business & Industry Association, said Summit is "a forward-thinking medical group" and the agreement Summit and Horizon announced is the sort generally known as "value-based purchasing," where compensation reflects efficiency and quality.
"Value-based purchasing holds a lot of promise for the business community in terms of helping to control costs but having as the premise ensuring quality," Stearns said. "That is precisely what employers ultimately want out of the health care system, and what their employees want. Everyone wants good quality health care at an affordable price."
Albano noted that Horizon for the past few years has been helping transform New Jersey primary care practices into patient centered medical homes, which get compensation from Horizon to coordinate patient care and focus on better outcomes; now there are 107 PCMH practices in the Horizon network, with about 1,000 physicians and other clinicians. Albano said the company's Horizon Healthcare Innovations division "has been focused on developing new relationships with providers focused on quality and cost efficiency metrics and results for patients, as opposed to just paying for service rendered on a fee for service basis." Horizon has also partnered with three accountable care organization around the state, that also are pursuing the goals of measurable quality and clinical outcomes; in 2013 Horizon expects to have as many as a dozen ACO relationships, Albano said.
The early results are that focusing on preventive care, and measuring the achievement of clinical goals, is gaining traction, Albano said. "Ultimately the goal here is to mitigate the increasing trend associated with health care and hopefully arrive at a place where health insurance is more affordable because we've cut out the waste and the duplication and incented and motivated the right things. And that means that cost of care comes down because outcomes are better: people are not missing the care they need they are getting the right care at the right time. All that translates into lower costs."
Albano said Summit "is absolutely a key addition to our network. It is an important group, well known for delivering quality care. There are employers around the state who have asked us to include them. It's clearly a positive for both Horizon and Summit."