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HBCBS launches new program focused on improving colonoscopies

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Horizon Blue Cross Blue Shield of New Jersey on Tuesday launched a new program focused on colonoscopies, which is are an extremely common diagnostic test designed to screen people for colon cancer.

In recent years, Horizon has launched programs to improve outcomes and lower costs in specific areas of medicine including joint replacement and pregnancy.

Horizon said this new program is designed to deliver better patient outcomes, improve patient experience and lower costs using incentives to increase the coordination of care. And if cost savings are achieved while quality benchmarks are met, doctors involved in the program will share in those savings.

Horizon joined with 31of its network doctors at more than 20 office locations for the program which will involve about 3,800 Horizon members in 2014.

This is the latest in a series of patient-centers programs launched by Horizon in the last several years, including patient centered medical homes for adults and for pediatrics. Currently, more than 500,000 of Horizon’s 3.7 million members are enrolled in a patient-centered program.

“This collaborative program with our network gastroenterologists continues Horizon’s effort to transform how health care is delivered by identifying specific treatments where we can improve patient care and lower costs,” said Jim Albano, vice president, network management and Horizon Healthcare Innovations for Horizon.

"This innovative program allows physicians to continue to provide excellent care to their patients while aligning the financial incentives between health care providers and Horizon,” said Dr. Charles Accurso of Digestive HealthCare Center.

Gastroenterologists participating in the program operate similar to a coach directing a team of health care professionals in the full-spectrum of care related to a patient’s colonoscopy. This includes the surgical procedure and all pre- and post-procedure services related to the colonoscopy. 

The initiative “showcases leadership and cooperation between participating gastroenterologists and Horizon to focus on enhancing care for the patient at all levels,” said Dr. George Pavlou of Gastroenterology Associates of New Jersey.

The gastroenterologists will closely monitor and work with outpatient sites of service, the anesthesiologist and other caregivers to ensure patients receive high-quality, efficient care.

Practices participating in the Colonoscopy Episode of Care Program include:

  • Digestive HealthCare Center – Seven physicians at three office locations in Hillsborough, Somerville and Warren.
  • North Jersey Gastroenterology Associates PA – One physician at three office location in Belleville, Kearny and West Orange. 
  • Gastroenterology LLC – One physician at two office locations in Vineland and Pittsgrove.
  • Gastroenterology Associates of New Jersey LLC – Sixteen physicians at multiple office locations in Wayne, Clifton, West Paterson, Oakland, Fair Lawn, Ringwood, Lincoln Park, Rutherford and Montclair. 
  • Woodbridge Medical Associates PA – One physician at one office location in Woodbridge.
  • R. Swami Nathan, MD – One physician at two office locations in Verona and Cedar Grove.
  • Advanced Gastroenterology Group – Four physicians at one office location in Union.

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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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