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HZBB 2013 PCMH results-1

Applies to: All markets

Horizon BCBSNJ’s 2013 study results demonstrate
patient-centered program improves patient care and lowers costs

Study findings confirm that Horizon Blue Cross Blue Shield of New Jersey’s patient-centered program is
working to improve the coordination of care and lower costs. The 2013 patient-centered study is the
largest to date and included more than 200,000 Horizon BCBSNJ members. Patient-centered care is an
innovative approach that focuses on delivering better quality outcomes, a better patient experience and
lowering the cost of care.

“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 BCBSNJ’s
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.”

2013 results
The 2013 study of claims data for more than 200,000 Horizon BCBSNJ members in participating
patient-centered doctors’ offices shows that patient-centered practices are performing better than
traditional practices in a number of clinical metrics. The study compares members in traditional
primary care practices with those practices participating in Horizon BCBSNJ’s Patient-Centered Medical
Home Program and found that patient-centered members had a:

• 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 more active care is being provided at a lower cost, as Horizon BCBSNJ
members in patient-centered practices had a:

• 4 percent lower rate in Emergency Room (ER) visits.
• 2 percent lower rate in hospital admissions.
• 4 percent lower cost of care for diabetic patients.
• 4 percent lower total cost of care.

Members under the care of a patient-centered practice were also able to avoid more than 1,200 ER visits
and 260 inpatient hospitals admissions, which represent a savings of approximately $4.5 million.

What “patient-centered” care means
“Patient-centered” care refers to an innovative approach 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 also financially rewarded to
improve the patient experience and improve patient care based on national clinical guidelines.
Patient-centered practices provide patients with more coordinated and personalized care, including:

• A care coordinator who provides additional patient support, information and outreach.
• Wellness and preventive care based on national clinical guidelines.
• Extra wellness support and education.
• Active patient monitoring and communication from the doctor and care coordinator.
• Active coordination of a patient’s care with specialists and other providers.

View how a patient-centered practice is improving the patient experience and coordinating and
personalizing the care for Horizon BCBSNJ members.

New plans and other programs
There are more than 3,700 network doctors in 900-plus patient-centered practice locations in Horizon
BCBSNJ’s patient-centered program. The patient-centered practices include doctors in Patient-Centered
Medical Homes (PCMHs), Accountable Care Organizations (ACOs) and practices focused on Episodes of
Care across New Jersey.

Horizon BCBSNJ recently intensified its commitment to patient-centered care by introducing two new
patient-centered health plans for small businesses with 50 or fewer employees. The new plans
encourage members to use patient-centered practices and are Horizon BCBSNJ’s lowest-cost small
employer plans at the Bronze and Silver levels. The premiums are 15 percent lower than the company’s
other plans.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

 

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