Patient-Centered Medical Home: A Successful Transformation for Better Healthcare Delivery in Horizon

Rationale / Objectives

The traditional, fee-for-service health care system generally treats patients after they become sick, and hospitals and doctors are paid for the amount of services they provide to those patients.2 This system creates high cost burden for patients with chronic conditions. Plus, ER has high pressure in unnecessary visits, which leads to a decrease in quality of care.

Project/Program Description & Major Achievements

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) initiated the value-based care program in New Jersey to enhance care and patients experience in 2012. Currently, there are more than 900 participated practices with more than 3,700 doctors in the state.

Lessons Learned

When joining Patient-Centered Medical Home program, every member in the practice, from the office manager to the care coordinator, has to put an emphasis on preventive care, or scheduling appropriate health screening for patients who may have come in for an entirely different issue.3 This is also part of patients’ responsibility as if they want help themselves.

Further Description

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) is transforming and improving New Jersey’s health care delivery system by collaborating and developing solutions to create a health care system marked by high-quality care, a better patient experience and improved affordability.1 Their purpose are to help improve quality outcomes and patient experience, doctors, nurse care coordinators and practice staff worked as a team to improve care coordination for Horizon BCBSNJ members within their practices.1 The Patient-Centered Medical Home (PCHM) Program increased reimbursement to support physicians for managing and improving the health of their patients while controlling the cost of care. Participating PCMH practices also had an opportunity to receive additional outcome-based or shared savings payments. This occurred when they met specified goals for delivering better quality care and controlling costs.1

Major Achievements

Horizon BCBSNJ’s PCMH Program is New Jersey’s largest PCMH initiative.1

Metric Result Detail
Hospital Visits: - Hospital admissions - ED visits Decreased 8% than patients served by traditional practices Decreased 5% than patients served by traditional practices Horizon Press Release (August 2015)
Improved Health: - Diabetes control - Cholesterol management for diabetic patients Increased 6% than patients served by traditional practices Increased 7% than patients served by traditional practices Horizon Press Release (August 2015)  
Cost saving - Reduction in  ER visits - Care for diabetic patients - Total cost of care Approximate savings of $4.5 million 4% decreased 4% decreased Horizon Industry Report (July 2014)