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Study: Patient-centered health programs are getting care, cost results

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A new study has found that medical care provided through innovative “patient-centered” programs is yielding both better-coordinated care and lower costs, according to Horizon Blue Cross Blue Shield of New Jersey. Horizon on Tuesday released results of a 2013 study of more than 200,000 members enrolled in various patient-centered programs.

“Our most recent study results clearly demonstrate the value of the patient-centered model, which will continue to improve and transform health care in New Jersey,” said Jim Albano, Horizon vice president of network management and Horizon Healthcare Innovations.  “The results also demonstrate the commitment of our participating doctors, nurses and care teams, and we look forward to expanding these efforts to benefit more of our members.”  

Horizon said it now has more than 500,000 of its members enrolled in patient-centered care. The 2013 study of claims data for more than 200,000 of them shows patient-centered practices are performing better than traditional practices in a number of clinical metrics, including:

  • 14 percent higher rate in improved diabetes control.
  • 12 percent higher rate in cholesterol management. 
  • 8 percent higher rate in breast cancer screenings.
  • 6 percent higher rate in colorectal cancer screenings. 

The study also shows that these patient-centered practices achieved lower costs, as evidenced by:

  • 4 percent lower rate of emergency room visits.
  • 2 percent lower rate of hospital admissions.
  • 4 percent lower cost of care for diabetic patients.
  • 4 percent lower total cost of care. 

Joel Cantor, director of the Rutgers Center for State Health Policy, said the numbers are impressive. 

“Clearly, Horizon sees patient-centered care models as the future; they are investing heavily in them,” Cantor said. “There is growing evidence from studies around the country that these models achieve better care at lower cost, particularly for patients with complex chronic illnesses. They also appear to improve access to care for patients overall.”

Horizon said “patient-centered” care refers to innovative approaches where health insurance companies provide incentives to doctors to meet certain clinical quality, patient satisfaction and efficiency benchmarks. Unlike the traditional fee-for-service model, patient-centered practices are financially rewarded to improve the patient experience and improve care based upon national clinical guidelines. 

The company said the study found that members in patient-centered practices avoided more than 1,200 emergency room visits and 260 inpatient hospitals admissions, which represent a savings of approximately $4.5 million. 

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, said: “The numbers are impressive. Giving providers data on their patients, paying providers to spend more time with their patients and provide more comprehensive and holistic care, and sharing savings with customers by reducing the cost of insurance premiums makes good sense. The next step will be to provide more information to consumers about the cost to them and the quality of the health care services out there. As networks narrow, consumers need to have the right information to make the best decisions for them, their family and their wallet.”

Horizon, the state’s largest health plan provider with more than 3.7 million members statewide, said it has 3,700 physicians in more than 900 locations in its patient-centered 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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