Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) recently announced the offering of a new patient-centered Medicare Advantage plan for Medicare-eligible consumers. The new plan features lower out-of-pocket costs and more coordinated care when members use Horizon BCBSNJ’s network of patient-centered practices, the largest in New Jersey.
“We have worked with doctors and hospitals to build New Jersey’s largest network of patient-centered practices, and we’re committed to extending the many benefits of this approach to our Medicare Advantage consumers,” said Erhardt Preitauer, CEO, Horizon NJ Health and Senior Vice President, Government Programs, Horizon BCBSNJ.
“Patient-centered” care refers to an innovative approach where health insurance companies use incentives to improve the quality, not quantity, of care patients receive from their health care professionals. Unlike the traditional fee-for-service model, patient-centered practices are rewarded when they improve the patient experience and improve patient outcomes with care based upon national clinical guidelines.
More than 500,000 members and over 3,700 doctors at 900 practice locations across New Jersey participate in Horizon BCBSNJ’s patient-centered programs, including Patient-Centered Medical Homes (PCMHs), Accountable Care Organizations (ACOs) and Episodes of Care programs.
Members have lower cost sharing with the new Medicare Advantage patient-centered plan, Horizon Medicare Blue Patient-Centered w/Rx (HMO), when they preselect and use a Primary Care Physician affiliated with one of Horizon BCBSNJ’s participating patient-centered doctor practices.
For the annual enrollment period from October 15 through December 7 (for coverage beginning January 1, 2015), the Horizon Medicare Blue Patient-Centered w/Rx (HMO) plan will be offered in 20 New Jersey counties (excluding Burlington County, where customers may purchase Horizon Medicare Blue Choice w/Rx (HMO).
The review of 2013 claims data demonstrate that patient-centered care works to improve the quality of care while lowering total health care costs. Claims data compared outcomes for more than 200,000 Horizon BCBSNJ members using patient-centered practices with outcomes for members using traditional primary care practices and found 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.
Results also showed 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 visits.
• 2 percent lower rate in hospital admissions.
• 4 percent lower cost of care for diabetic patients.
• 4 percent lower total cost of care.
Patient-centered practices provide patients with more coordinated and personalized care, including:
• Access to physicians who are working to transform health care delivery with a team of professionals, 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.
• Proactive communication by the PCP to respond to member needs and monitor their health.
• Access to PCPs who work closely with specialists, other medical providers and health care facilities to centrally coordinate a patient’s care.Related Articles: