Horizon Healthcare Innovations, LLC, a wholly-owned subsidiary of Horizon Blue Cross Blue Shield of New Jersey, has teamed up with 63 physicians in New Jersey to launch a statewide PCMH. To help the process along, Horizon is funding population care coordinators to be embedded in physicians' offices.
Having worked collaboratively with the New Jersey Academy of Family Physicians (NJAFP) for more than two years, said Nicholas Bonvicino, MD, the senior medical director and pilot lead at Horizon Healthcare Innovations, Horizon found that physicians didn't want or need pamphlets and brochures offering guidance to move to the PCMH model.
"What physicians needed most of all was skilled staff – actual people in their offices navigating people through the complexities of the healthcare system," said Bonvicino.
[See related story: Study: Medical home model increases quality of care, reduces cost]
Horizon Innovations decided to take a page from Geisinger Health System by paying for a staff person – called a population care coordinator – to work in the offices of physicians participating in its PCMH pilot program.
Physicians had a mixed response to Horizon's offer of paying for an employee that would work in their offices as a staff member, said Bonvicino. "Physicians recognized they needed assistance and were appreciative, but I think they would have appreciated being paid more so they could hire their own staff."
Having a Horizon-funded staff member in the offices of physicians in the PCMH pilot program made the company feel more secure that it would get a focus on its members and the results it wants. "There was a concern that if we just paid physicians more money," Bonvicino said, "[Horizon would] not see it re-invested in the processes that would drive the outcomes we wanted to see – better cost of care over a total population [and] measurable improvements in quality."
Having an employee with PCMH skills – who can manage data, identify gaps in care, identify high-risk members and who can coordinate care between facilities, among other things – will help physicians' offices transition more smoothly, Horizon officials believe. The company anticipates that some physicians' offices will make the transition more quickly, but they have planned for a two-year transition for most offices. Once an office is successfully transitioned, Horizon "will remove the resource [the population care coordinator] and increase the reimbursement to the practice," said Bonvicino.
Horizon launched the PCMH pilot program in January after spending an intense summer working with members of NJAFP to create a pilot program beneficial to all parties. "Building medical homes is the first step – and very critical – if we're going to improve the healthcare system," said Bonvicino.
Eight practices are currently in the pilot program. Six practices have Horizon-funded population care coordinators working in their offices. Bonvicino said Horizon is starting small but has ambitious growth plans for expanding the pilot in July by 25 to 30 practices and will examine how things are going in six months. If need be, the company will slow down and make adjustments.