NEWARK, NJ – Horizon Blue Cross Blue Shield of New Jersey and Partners in Care are expanding their Patient-Centered Medical Home pilot, which manages the care of just under 1,400 diabetics, to one that manages 8,000 diabetics.
“The continued decrease in the cost of care for the pilot population” and the overall performance, including high levels of patient compliance, are driving the expansion, said Bruce Dees, executive vice president of PIC, an 850-member physician organization.
“After the initial bump of cost, the ROI is going to be spectacular,” he said.
PCMHs are “the buzz all over the place,” said Richard Popiel, MD, vice president and CMO of Horizon. At the end of 2007, 29 Blues plans had begun PCMH programs.
Besides the increase in number, Popiel said that the difference today is integrating value-based design – aligning reimbursement with coordination of care – into the PCMH.
On the heels of the success and expansion of the Horizon-PIC PCMH, Horizon is rolling out two more pilots. The first is a collaboration between the payer and a primary care society.
The second pilot is a collaboration between the payer and three hospitals. “With this pilot, we will try to understand what the role of the hospital is in the medical home,” said Popiel.
“We need to understand what undercurrent alignment strategy needs to be in place,” he said, to address the problem of individual physicians working in their own silos and physicians working in silos within the hospital setting.
“There’s definitely a clear trend on attention to medical homes,” said Lynne Dunbrack, program director for Health Industry Insights, noting that PCMHs are part of employer groups’ health and wellness programs and also complement pay-for-performance.
“The challenge is getting incentive alignment as various models emerge and working through different creative means of getting technology into the hands of physicians,” she said.
Michael Barr, vice president of practice advocacy and improvement for the American College of Physicians, noted that despite the multitude of demonstration projects, including one by the Centers for Medicare & Medicaid Services, there’s a general lack of understanding of a PCMH’s attributes.