Horizon Blue Cross Blue Shield of New Jersey


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Patient-Centered Medical Home

The patient-centered medical home (PCMH) concept, in its most basic form, is a model of care where a patient's personal physician directs a team of healthcare providers in the comprehensive planning and treatment of a patient. The personal physician takes responsibility for arranging appropriate, evidenced-based care at the practice level and involves the patient in the treatment planning process, which could include the involvement of the patient's family and available community resources. This model is particularly useful for patients with chronic illnesses.

In January 2007, Horizon Blue Cross Blue Shield of New Jersey launched a PCMH Pilot program with Partners In Care (PIC), a physician run organization that represents 850 physicians and serves over 1 million patients. PIC delivers and coordinates $2 billion in annual healthcare expenditures.

The pilot program's goal was to improve quality of care and clinical outcomes for people suffering with diabetes. Over 1,300 Horizon BCBSNJ members, all members of the State Health Benefits Plan, took part in the pilot program.

Key results are as follows:

  • Prior to the start of the program in January 2007, only 60 percent of the patients with diabetes had taken the critical HbA1c blood test, an important screening that shows the effectiveness of blood sugar control. By January 2008, 92 percent of the patients had taken the test.
  • Prior to the start of the program in January 2007, only 33 percent of the patients with diabetes had taken an LDL diabetic blood test, which measures cholesterol. By January 2008, 88 percent of the patients had taken the test.
  • Total healthcare costs for these patients between January 2007 and January 2008 were reduced by approximately 12 percent.

In January 2008, the program was expanded to include an additional 6,000 New Jersey State Health Benefit members with diabetes.

Key results are as follows:

  • Only 41 percent of the new patients to the program had taken the HbA1c blood test to monitor their effectiveness in controlling their blood sugar. One year later, in January 2009, 72 percent of those patients had taken this critical blood test.
  • Only 48 percent of the new patients had taken the LDL diabetic blood test in January 2008. By January 2009, 72 percent of those patients had taken the test.
  • Total healthcare costs for these patients between January 2008 and January 2009 were reduced by approximately 10 percent.

The initial results of the pilot programs were encouraging. As a result, Horizon Blue Cross Blue Shield of New Jersey has begun a new collaboration with the New Jersey Academy of Family Physicians to expand the number of members utilizing a patient-centered medical home.