5 Core Elements of Horizon’s Patient-Centered Medical Home

Engaging, educating and empowering patients is one of the core pieces that make up the PCMH, says Jay Driggers, director of consumer experience and engagement, Horizon Blue Cross Blue Shield of New Jersey. While other primary elements — payment reform and care coordinators — are key to this healthcare model’s success, without patient engagement, the model will not be as successful as it could be, Driggers says.

There are five core elements to our patient-centered medical home (PCMH) model. There’s the payment reform, which is how we focus on incenting and rewarding providers. We pay them differently. We pay them additional care coordination fees: there’s an outcomes-based payment approach, so if they achieve a certain level of quality threshold or reduced cost threshold, there is additional money available to them for that strong performance.

There’s a population care coordinator. We have a team-based model here. It’s not just a primary care provider (PCP) any more, it’s a full care team. And we either provide a subsidy for our practices to hire a population care coordinator, or we provide a population care coordinator to sit in their practice as part of the team and help focus on high-risk patients, closing gaps in care, etc.

I mentioned ‘collaborative approach.’ We’ve built a very robust playbook of best practices that a PCMH practice can do to improve their performance in our program. Then, we built a peer-to-peer network so physicians can learn best practices from their peers — learning from those who have been in their shoes and done it.

There’s data and technology; between electronic medical records and our claims records, there’s a lot of information that we want to be able to share. We’re building capabilities there to work more efficiently and effectively with our PCMH partners.

Lastly, there are the patient engagement components that complete our five tenets. We very strongly believe that if we don’t focus on engaging the patient in the model, we will not be as successful as we need to be.

New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care

New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care
New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care. Beginning with an overview of 2012 PCMH trends, this 57-page special report offers snapshots of thriving medical home initiatives and their particular area of focus.

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