NEWARK, NJ – Partners in Care and Horizon Blue Cross Blue Shield of New Jersey’s one-year pilot on the patient centered medical home (PC-MH) has demonstrated improved clinical outcomes and lowered total healthcare costs.
Early validation of the wellness-based PC-MH model, in which a primary care physician coordinates patient care, presents an opportunity to reverse the current crisis in primary care, said Richard Popiel, MD, vice president and CMO of Horizon BCBSNJ.
“We tend to pay more for procedure-based care and less for cognitive-based care,” he said, despite the fact that low PCP reimbursement for this healthcare delivery is not sustainable.
“This is an important issue for our country to face. This is a step for all plans to consider,” he said of the PC-MH model.
The collaboration between payer and provider to enable sharing of clinical and financial information and transparency is the “cornerstone” of the program, said Kevin O’Brien, president and CEO of PIC.
Popiel said Horizon BCBSNJ shared its patient data with PIC to create a baseline to determine how much would be spent on individuals to achieve a level of quality, and then subsequently how much it cost for that care.
The program aligns payment with resources. “If you provide the information, funding and resources, most physicians will want to participate,” O’Brien said. “The bottom line is when you don’t pay for coordination, physician engagement won’t happen. This is a rewarding process for us. It demonstrates that we can get aligned.”
The most dramatic finding of the pilot was the HbA1c blood test, which indicates how well diabetes is being treated. According to NCQA standards, below a level of 7 means the patient is doing well. Before the PC-MH model was implemented, only 33 percent of the targeted patient population – New Jersey State Health Benefits Program members with diabetes – had a reading of below 7. At the end of the pilot, that percentage had increased to 56.
O’Brien feels the PC-MH model is the answer. The guts of the pilot, he said, was studying the literature put out by such organizations as NCQA, Bridges to Excellence and the Center for Health Value Innovation; aligning efforts, information and funding to what should be done; and practically applying what was learned from these organizations.