New Jersey's largest insurer is expanding its medical home program in an effort to boost primary care access and member satisfaction, as new competitive threats loom from non-traditional insurers.
Horizon Blue Cross Blue Shield of New Jersey is expanding its patient-centered medical home (PCMH) program to more than 750,000 members, almost 20 percent of its membership.
The decision comes after promising results in the the insurer's medical homes, which covered 200,000 members last year and feature robust access to a primary care physicians, a care coordinator who handles support and outreach, wellness and preventive care and ongoing patient monitoring.
Horizon reviewed the claims of medical home-covered members compared to non-PCMH members in 2013, and found a range of benefits in both costs and outcomes.
Those in the medical homes had a 14 percent higher rate of improved diabetes control, a 12 percent higher rate of cholesterol management, an 8 percent higher rate of breast cancer screenings and a 6 percent higher rate of colorectal cancer screenings. PMCH-covered members also had a 4 percent lower rate of emergency room visits, a 2 percent lower rate of hospital admissions, a 4 percent lower cost of care for diabetics and a 4 percent lower total cost of care for all membership.
"Horizon is committed to transforming how healthcare is delivered in New Jersey," said Robert Marino, chairman and CEO of Horizon BCBSNJ. "With this expansion, we continue to lead this effort with innovative doctors across this state, benefiting more than 750,000 of our members. We will continue to expand our patient-centered programs so that more of our members benefit from more coordinated and efficient patient care."
Horizon BCBSNJ's patient-centered programs currently include more 6,000 doctors participating in both PCMHs, ACOs and episode-of-care contracts, and the company is betting on using these new kinds of provider relationships to manage the transition through health reform.
The embrace of medical homes as a route to better healthcare also comes as Horizon's leading 45 percent market share is under fire from a range of competitors.
One source likely to heighten competition in the group insurance market is QualCare Alliance Networks, a provider-sponsored managed care company that Cigna is in the midst of acquiring. With QualCare's membership, Cigna will have a footprint of nearly 700,000 health plan customers in the Garden State.
Add to that two startup insurers vying in both the individual and group spaces: the cooperative Health Republic Insurance of New Jersey and the New York City startup Oscar Health Insurance. Those two also happen to be working with QualCare.
QualCare is supplying Health Republic with provider networks, customer service, medical management and claims processing, while Oscar is using QualCare's HMO network as its exclusive network partner for its foray into New Jersey's individual and small group market.
For Horizon, as with other state and regional Blue Cross insurers, the great challenge in health reform is leveraging a well-known brand to attract and retain members as they move between eligibility for individual plans, employer plans and Medicare Advantage. A better, more comprehensive primary care experience is one strategy they're using.