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Horizon launches ACO with Partners In Care

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    Horizon Blue Cross Blue Shield of New Jersey, the state’s largest health insurer, announced Monday that it has launched a new collaborative Accountable Care Organization with Partners In Care, a physician-owned healthcare management company based in East Brunswick.

    The ACO, which began on Jan. 1, covers more than 20,000 Horizon members who are patients of 51 of PIC’s primary care member practices. The goal is to better coordinate the care those Horizon members receive to produce better health care at lower costs.

    PIC has expertise in care coordination and population health management, and has worked to improve medical care and reduce spending on behalf of other insurers, including Aetna and Cigna, as well as for self-insured public and private sector employers.

    The ACO is the latest healthcare system transformation initiative by Horizon, which has been developing patient centered medical homes and other new care models.
     
    “This agreement with Partners In Care is another important step toward transforming how patient care is delivered in New Jersey with stronger coordination, a better patient experience, and lower cost of care for Horizon members,” said Jim Albano, vice president of network management and Horizon Healthcare Innovations at Horizon.

    Ralph Tang, chief executive of PIC, is pleased with the partnership.

    “As early pioneers with more than 18 years of experience in care coordination, population health and accountable care, we are excited about collaborating with Horizon in improving patient care,” he said. “We are proud to have a track record of working with health insurers and self-insured employers to measurably improve the health of their members and employees while bending the cost curve. We achieve these outcomes by working with and through our extensive and growing network of primary care and multi-specialty providers. We look forward to delivering similar results to Horizon and its members.”

    Horizon will provide care coordination payments to the ACO to take on additional accountability for improving the health and patient experience as well as controlling the cost of care.

    Horizon said the ACO and its affiliated practices have an opportunity to share in the resulting savings, provided the ACO meets certain health improvement, patient satisfaction and cost goals.
     
    Tang said the 51 practices in the ACO are among PIC’s more than 420 physicians and health care professionals in central and southern New Jersey.

    “The work we will be doing with Horizon is very much a reinforcement of the accountable care concept and practice that is maturing in this industry as the industry transforms from fee-for-service to an outcome-based, value-based model,” Tang said.

    He said the 20,000-plus Horizon members in the new ACO will include members of job-based health plans and Medicare recipients.

    Horizon will make care coordination payments to the ACO, and the physician practices will share in those funds.

    Those additional funds will benefit the practices, Tang noted.

    “As we ponder over the transformation of health care in the primary care setting, oftentimes doctors are finding it hard to keep their practices alive,” he said. The care coordination payments from Horizon “are another way to add revenue to their practice.

    In addition, by working with us on care coordination, it is a way to transform the practice in small steps toward delivering accountable care in more effective and efficient fashion.”

    The work of care coordination that PIC performs includes encouraging the chronically ill to get the medical care they need, and encouraging those who are healthy to get regular preventive screenings.

    Tang said the 51 practices will benefit from the additional revenue and the introduction of best practices that are “different in terms of being more accountable and more value driven toward delivering better care for the patient.

    “I believe that the outcome is going to be a much higher performing practice in our network.”




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    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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