Horizon Blue Cross Blue Shield of New Jersey’s Patient-Centered Medical Home Program

Program Location: 
Newark, NJ
Number of Practices: 
900
Payer Type: 
Commercial
Payers: 
Horizon BCBSNJ

Reported Outcomes

Description: 

Horizon Blue Cross Blue Shield of New Jersey is transforming and improving New Jersey’s health care delivery system by collaborating and developing solutions to create a health care system marked by high-quality care, a better patient experience and improved affordability.

In 2011, Horizon BCBSNJ, the New Jersey Academy of Family Physicians and the leadership of eight primary care practices collaborated to launch New Jersey’s first comprehensive, state-wide PCMH Program. Horizon BCBSNJ’s PCMH Program is New Jersey’s largest PCMH initiative. To help improve quality outcomes and patient experience, doctors, nurse care coordinators and practice staff work as a team to improve care coordination for Horizon BCBSNJ members within their practices. Horizon currently has more than 900 patient-centered-care practices with more than 3,700 doctors. 

On January 1, 2015, Horizon will join other Blue Cross Blue Shield organizations in offering covered members access to patient-centered programs in other states. For more information on the expansion of the Blue Cross Blue Shield PCMH program click here. 


The purpose of Horizon BCBSNJ's patient centered practices is to provide patients with more coordinated and personalized care, including:

  • A care coordinator who provides additional patient support, information and outreach.
  • Wellness and preventive care based on national clinical guidelines.
  • Extra wellness support and education.
  • Active patient monitoring and communication from the doctor and care coordinator.
  • Active coordination of a patient's care with specialists and other providers.
Payment Model: 

The PCMH Program increases reimbursement to support physicians for managing and improving the health of their patients while controlling the cost of care. Participating PCMH practices also have an opportunity to receive additional outcome-based or shared savings payments provided they meet specified goals for delivering better quality care and controlling costs.  

In July of 2014, Horizon announced its new Patient-Centered Advantage EPO plans. The two plans, one silver and one bronze, have premiums about 15 percent lower than Horizon's current lowest price plans for small employers. When members of the new plans see primary care physicians at those practices, the in-network deductible ($2,500 for bronze plans, $2,000 for silver) does not apply, there is no co-insurance, and copayments are $40 for bronze and $20 for silver.

Fewer ED / Hospital Visits: 

Horizon Press Release (August 2015) evaluation of 750,000 patients participating in Horizon patient-centered practices

  • 8% lower rate of hospital admissions (compared to patients served by traditional practices)
  • 5% lower rate of ED visits (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

  • 4% lower rate of Emergency Room visits (among all patient-centered practices)
  • 2% lower rate of hospital admissions (among all patient-centered practices)

Horizon Industry Report (July 2013)

  • 23% lower rate in hospital inpatient admissions.
  • 12% lower rate in Emergency Room (ER) visits.
Improved Health: 

Horizon Press Release (August 2015) evaluation of 750,000 patients participating in Horizon patient-centered practices

  • 6% higher rate in improved diabetes control (compared to patients served by traditional practices)
  • 7% higher rate in cholesterol management for diabetic patients (compared to patients served by traditional practices)
     

Horizon Industry Report (July 2014) 

  • 14% higher rate in improved diabetes control
  • 12% higher rate in cholesterol management

Horizon Industry Report (July 2013)

  • 5% higher rate in improved diabetes control (HbA1c)
Cost Savings: 

Horizon Press Release (August 2015) evaluation of 750,000 patients participating in Horizon patient-centered practices

  • 9% lower total cost of care (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

  • aproximate savings of $4.5 million (due to reduction in ER visits and inpatient hospital amissions)
  • 4% lower cost of care for diabetic patients (among all patient-centered practices)
  • 4% lower total cost of care (among all patient-centered practices)

Horizon Industry Report (July 2013)

  • 9% lower cost of care for diabetic patients
Increased Preventive Services: 

Horizon Press Release (August 2015) evaluation of 750,000 patients participating in Horizon patient-centered practices

  • 8% higher rate in colorectal cancer screenings (compared to patients served by traditional practices)
  • 3% higher rate in breast cancer screenings (compared to patients served by traditional practices)

Horizon Industry Report (July 2014) 

  • 8% higher rate in breast cancer screenings
  • 6% higher rate in colorectal screenings

Horizon Industry Report (July 2013)

  • 3% higher rate in breast cancer screenings
  • 11% higher rate in pneumonia vaccinations
Last updated August 2015
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