N.J.’s Biggest Health Insurer Touts New Business Model

July 25--The state's biggest health insurer thinks that it has found a business model that will deliver better care less expensively.

Horizon Blue Cross Blue Shield of New Jersey said Wednesday that patients in the fast-growing program were less likely to be admitted to the hospital and more likely get preventative care, cutting their overall health care bills by 6 percent.

"It continues to validate the work that we're doing, the collaboration, really, with primary care practices," said Steven Peskin, senior medical director of clinical innovations for Horizon.

Newark-based Horizon has 3.6 million members. Among them are 320,000 who are participating in what it calls its patient-centered programs in which their doctors are paid extra for the outcome of the care they get.

It is part of a sweeping change in the health care industry that has prompted doctors to team up with insurers, hospitals and other doctors. The idea is that better collaboration -- and a new payment model -- will both slow down the skyrocketing cost of health care and improve patients' health.

Integrated Medical Alliance, a Shrewsbury-based practice with 30 doctors from a cross-section of specialties, is participating in the Horizon program, which has prompted changes, said William Febus, chief executive officer.

Doctors treating patients with high blood pressure, for example, are rewarded for lowering their blood pressure through prescriptions ranging from medication to exercise. The practice hired a registered dietitian six months ago. It has three walk-in clinics to treat patients who otherwise might have gone to more expensive emergency rooms, Febus said.

Nurses employed by Horizon visit the offices to help with care.

"What they really want is a full team approach to patient care, including the assistance of the patient," said Brendan Mulholland, a family practice doctor in Red Bank who is the president of IMA. "There's a whole team involved looking at the patient's chart, making sure things are done before the office visit, creating a care plan for them to take home with them."

Horizon launched its patient-centered program in 2011, and it has grown quickly, from 63 doctors at the outset to 1,400 today.

Through Horizon's program, doctors are paid a fee for services. But they also receive money to hire staff to coordinate care, and they are paid if their patients reach targets.

The insurer, reporting results from 2012, said patients in the program:

-- Had a 3 percent higher rate of breast cancer screenings.

-- Had an 11 percent higher rate of pneumonia vaccinations.

-- Had a 23 percent lower rate of hospital inpatient admissions.

-- Had a 12 percent lower rate of emergency room visits.

Michael L. Diamond: 732-643-4038; mdiamond@ njpressmedia.com

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