Horizon BCBSNJ Metrics Affirm Patient-Centered Model for Improving Care, Lowering Cost

Patient-centered practices are performing better than traditional practices in a number of clinical metrics, including improving diabetes and cholesterol management, according to the results of a study from Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ).

The study of claims data for more than 200,000 Horizon BCBSNJ members in participating patient-centered doctors’ offices compares members in traditional primary care practices with those practices participating in Horizon BCBSNJ’s patient-centered medical home (PCMH) program and found that patient-centered members demonstrated the following outcomes:

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

The study also shows that more active care is being provided at a lower cost. Key findings among those Horizon BCBSNJ members in patient-centered practices include the following:

  • 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; and
  • 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 hospital admissions, which represent a savings of approximately $4.5 million.

Patient-centered practices provide patients with more coordinated and personalized care, including care coordinators who provide 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, and active coordination of a patient’s care with specialists and other providers.

There are more than 3,700 network doctors in 900-plus patient-centered practice locations in Horizon BCBSNJ’s patient-centered programs. The patient-centered practices include doctors in PCMHs, accountable care organizations (ACOs) and practices focused on episodes of care across New Jersey.

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

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