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Horizon's ACA pilot programs are now in full flight

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A few months after Congress passed the Affordable Care Act in 2010, New Jersey’s largest health insurer launched a pilot program aimed at moving the company toward the new future envisioned by the ACA, one where the health care system delivers better quality while controlling the nation’s skyrocketing health care spending.

Dr. Steven R. Peskin, senior medical director for clinical innovations at Horizon Blue Cross Blue Shield of New Jersey, said the insurer now has 500,000 of its 3.7 million members in these new “patient-centered” programs, which reward providers financially for lowering costs and raising quality.

“We’ve gone from pilot to program,” Peskin said. “This is really the wave of the future, the way we are doing business right now. These are programs; they are not pilots anymore.”

The programs include patient-centered medical homes, which are primary care practices where doctors and care coordinators keep tabs on chronically ill patients and make sure those who are healthy get flu shots and preventive screenings.

In addition, thousands of New Jersey children are now getting care in Horizon’s patient-centered pediatric practices. Other programs are focused on specific procedures, such as joint replacement surgery. And last month, Horizon launched a program designed to better coordinate care during pregnancy and delivery.

Horizon said it now has 2,800 doctors working in patient-centered programs at nearly 900 locations in every county in the state.

“We set a very high bar for ourselves for 2013, which was to reach 500,000, and we exceeded that,” Peskin said. And he said Horizon grew the program while “sustaining the improvement in quality and value.”

The traditional model of medical care is fee-for-service: Health care providers have been paid for everything they do, regardless of their impact on patient health. To get the system to instead reward value, Horizon pays doctors an additional “care coordination fee” to cover the cost of coordinating the care patients receive. Typically, care coordinators are specially trained nurses.

For physicians who manage to improve outcomes and hold down costs, “there is an additional reimbursement, an ‘outcome-based payment,’ which is not guaranteed but is earned and deserved,” Peskin said. Horizon estimates that physicians in patient-centered practices are receiving about 20 percent more revenue.

Patients seem to like patient-centered care, too, Peskin said.

“Patients are very much gravitating to and appreciating this notion of person-centered, team-based care,” Peskin said. “If the person has a chronic condition like diabetes or obstructive lung disease or heart failure, they are getting additional attention and coaching and education that helps them with their own self-care — a greater awareness of the things they can do to feel better and have a better quality of life.”

Dr. Jack Feltz is president of Lifeline Medical Associates, the state’s largest obstetrics practice with more than 100 physicians in 50 locations around the state. Lifeline is one of the practices in Horizon’s new patient-centered pregnancy and delivery program.

He said Lifeline’s offices all use a common electronic medical record system and share best practices. “As a group, we can afford higher-quality equipment, higher-quality staffing, higher-quality IT — tools that many physicians have been missing over the years to be able to provide the best care possible.”

E-mail to: beth@njbiz.com
On Twitter: @bethfitzgerald8

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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