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Horizon says patient-centered care model improving both costs, outcomes

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Fewer hospital admissions and trips to the ER, and better and less costly diabetes care, are among the 2012 results of the patient-centered medical home program of Horizon Blue Cross Blue Shield of New Jersey, the insurer announced today.

Horizon said it plans increase enrollment in medical homes, which seek to coordinate medical care in order to improve quality while lowering costs.

Horizon said when compared to its members in non-PCMH medical practices, the 70,000 PCMH members it surveyed had:

– 5 percent higher rate of improved diabetes control.
– 3 percent higher rate of breast cancer screenings.
– 11 percent higher rate of pneumonia vaccinations.
– 23 percent lower rate of hospital inpatient admissions.
– 12 percent lower rate of ER visits.
– 9 percent lower cost of care for diabetic patients.

Horizon also said that in 2012, the per patient/per month costs were 6 percent lower for those in the PCMH, compared to the general Horizon population, while the use of generic drugs was 3 percent higher for the PCMH.

"What this shows is the power of having care coordiantion on the ground, in people's homes, in the doctor's offices," said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute. Schwimmer previously worked at Horizon, where she helped launch the PCMH program.

The PCMH employs patient care coordinators, usually specially trained nurses, who create personal care plans for patients at high risk of complications from their illnesses.

Dr. Roger Thompson, of Integrated Medicine Alliance in Monmouth County, a PCMH, said the program "has helped us deliver proactive outreach programs to discover obstacles to proper care, fill gaps in care, and to engage patients and encourage participation in making their own health care decisions."

Horizon said it plans to expand its PCMH program by another 80,000 patients. There are 240,000 currently enrolled in PCMHs, it said.

Reporter Beth Fitzgerald is @BethFitzgerald8 on Twitter.

Beth Fitzgerald

Beth Fitzgerald

Beth Fitzgerald reports on health care, small business and higher education. She joined NJBIZ in 2008 after a 34-year career at the Star-Ledger and has been reporting on business in New Jersey since 1978. Her email is beth@njbiz.com and she is @bethfitzgerald8 on Twitter.

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