A new pilot program, based on the Patient Centered Medical Home, (PCMH)  will strengthen the relationship Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)  members have with their personal physicians to improve the quality of care and reduce health care costs. 

The pilot program is a collaboration between Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and the New Jersey Academy of Family Physicians (NJAFP) that will use elements of the PCMH model of care to improve health outcomes for Horizon BCBSNJ members.  

The PCMH model of health care delivery is provided to patients in their primary care physician’s (PCP) office.  The PCP leads a care delivery team that improves the coordination of care to meet all of the health care needs of the patient while strengthening the relationship between physician and patient.

Horizon BCBSNJ will provide initial seed funding to support the infrastructure of the new pilot program.

“This new collaboration with the New Jersey Academy of Family Physicians furthers Horizon Blue Cross Blue Shield of New Jersey’s commitment to improving the health of our members through the Patient Centered Medical Home model,” said Dr. Richard Popiel, Vice President and Chief Medical Officer, Horizon BCBSNJ. “The Patient Centered Medical Home has already shown great promise in helping improve the outcomes of people struggling with chronic illnesses and we expect similar results with this program.”

“It is becoming increasingly apparent that adoption of the Patient Centered Medical Home, or PCMH, model of care offers patients improved health outcomes, while lowering the overall cost of care” said Ray Saputelli, Executive Vice President, NJAFP. “The PCMH concept emphasizes the “high-touch” nature of primary care that family physicians have traditionally provided to patients. In addition, this care model, provided in the patients' primary care physician office, also fosters a healthcare team approach and the use of health information technology. This pilot project provides the opportunity to take the first steps towards assisting physician practices with the transformation necessary to operationalize the PCMH model of care within their office."

About the Program

This pilot program is based on the NCQA Physician Practice Connections – Patient-Centered Medical Home (PPC – PCHM) Recognition Program which focuses on the following key elements:

• Access and Communication – Focuses on patient access to the practice including after office hours and patient physician/practice communications.

• Patient Tracking and Registry Function – Assesses electronic data system that physician/practice can use including searchable databases and clinical information, as well as paper-based systems or electronic systems to organize and document clinical information and population management.

• Care Management – Identifies if physician/practice implements evidence-based guidelines for patient care includes an overall practice care team and how continuity of care is coordinated.

• Patient Self-Management Support – Examines the physician/patient relationship, including resources and goals to enhance patient self-management capabilities.

• Test Tracking – Includes use of e-prescribing and electronic decision-support capabilities and efficiencies.

• Referral Tracking – Looks at how the physician/practice improves effectiveness of care, patient safety and efficiency, relating to tracking information on tests and lab results.

• Performance Reporting and Improvement – Focuses on physician/practice abilities and process to improve effectiveness, efficiency and timeliness by measuring and reporting quality information though regular physician/practice feedback.

• Advanced Electronic Communications – Assesses if physician/practice has engaged in use of electronic formats and systems to maximize performance, efficiency, effectiveness and coordination of patient care.

• Interoperability – Examines capacity of physician/practice to use electronic formats and systems to maximize performance, efficiency, effectiveness and coordination of patient care.

This one-year pilot program will be implemented by approximately 25 to 50 primary care physician practices across New Jersey. Physicians will use their previously implemented electronic health record systems, or will be offered technology developed by MDclickTM, a comprehensive registry program, to meet the technological requirements of the pilot program.

About Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ)

Horizon Blue Cross Blue Shield of New Jersey is the oldest and largest health insurer in the state serving over 3.6 million members. Horizon BCBSNJ is New Jersey's only not-for-profit, health services corporation and is headquartered in Newark with offices in Wall, Mt. Laurel, and West Trenton.

Horizon BCBSNJ provides a broad array of health and dental insurance products and services for individuals and small and large companies, including national companies headquartered in New Jersey.   Horizon BCBSNJ is committed to improving the health care experience for all the communities we serve as well as helping our members become and stay healthy.

Horizon BCBSNJ’s Web site is located at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross Blue Shield Association.

About The New Jersey Academy of Family Physicians (NJAFP)

The New Jersey Academy of Family Physicians has been advancing the cause of family physicians and their patients for over 50 years. With nearly 2,000 members, including active practicing family physicians, residents in Family Medicine, and medical students interested in the specialty, NJAFP is the largest primary care medical specialty society in New Jersey. NJAFP is also a constituent chapter of the American Academy of Family Physicians (AAFP), the largest medical specialty association in the U.S. The AAFP represents over 96,000 members, including 420 Family Medicine Residency programs with over 10,000 residents.

NJAFP’s mission is to advance and promote the specialty of family medicine through education and advocacy which serves to benefit the health of the public and the practice environment of our members.