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Horizon's new health plan offers deep discounts for using ACOs and PCMHs

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The push toward patient-centric health care increases.

Horizon Blue Cross Blue Shield of New Jersey announced Thursday it is offering a new health plan to employers that gives their workers a financial incentive to get their care at patient-centered medical homes and accountable care organizations.

Members who receive services from a PCMH or an ACO will pay 66 percent lower co-payments than those who do not, or $10 rather than $30.

Joel Cantor, director of the Center For State Health Policy at Rutgers, agreed with the move.

"Enhanced primary care models are at the cutting edge of healthcare delivery reform, and Horizon has been a leader in advancing these models in New Jersey," he said. "While these models are well known to those working in health services, this may not be the case in the general public."

In theory, PCMHs and ACOs seek higher quality and lower costs by providing consistent preventive care and by coordinating the care patients get from doctors and other clinicians.

"It will be interesting to see if employers recognize how this product is different, and perhaps better, than standard provider networks," Cantor said. "If the market is attracted to patient-centered models, it is likely that these new approaches will spread more quickly. That would be a good thing."

Horizon, which since 2011 has been leading an effort with physicians, hospitals and health care leaders throughout the state to transform how health care is delivered, said its new Horizon Patient-Centered Advantage EPO Plan is now being offered to employer groups for insurance coverage effective on Jan. 1, 2014.

Linda J. Schwimmer, vice president of the New Jersey Health Care Quality Institute, said this new Horizon health plan will increase awareness of PCMHs.

"Most people have no idea what this is, and now they will have an incentive to seek out a doctor that is a PCMH, so that is a good thing," she said.

Schwimmer said the new product puts pressure on the providers to deliver on the promise. But she offered a warning.

"(This will only work) if the providers actually do manage patients well and have all the things that drive down cost," she said. "There are specific things the doctors are going to need to do to drive down costs and hit the quality metrics."

More than 320,000 Horizon members and 1,400 doctors currently participate in Horizon's patient-centered programs. The company said early results indicate the new approach is working with an increase in patient preventive care, 23 percent fewer inpatient hospital admissions, and 12 percent fewer emergency room visits.

"Our patient-centered programs reward physicians when the care they deliver produces better health outcomes, is better coordinated, and more efficient and this new product helps employers encourage their employees to take advantage of this new approach," said Christopher M. Lepre, senior vice president of Horizon's Market Business Units.

Horizon said the Horizon Patient-Centered Advantage EPO plan members will receive:

- Access to physicians who are working to transform health care delivery with a team of professionals, including a care coordinator who provides additional patient support, information and outreach.

- Wellness and preventive care based on national clinical guidelines.

- Extra wellness support and education.

- Proactive communication by the primary care physicians to respond to member needs and monitor their health.

- Access to PCPs who work closely with specialists, other medical providers and health care facilities to centrally coordinate a patient's care.

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