Patient-centered care continues to deliver on promise of better quality care at a lower cost

Members receiving care from a doctor who participates in a patient-centered program are scoring higher on quality care metrics – at a cost that is nine percent lower -- than those members at traditional doctor practices, according to the 2014 results of Horizon Blue Cross Blue Shield of New Jersey's patient-centered programs.

"The promise of patient-centered, or value-based, care to deliver better quality care at a lower cost is no longer theoretical, it's a reality," said Robert A. Marino, chairman and CEO of Horizon BCBSNJ. "The 2014 results further demonstrate how doctors, hospitals, and Horizon are innovating and transforming health care to ensure patients receive more coordinated, better quality care at a lower cost."

More than 750,000 Horizon BCBSNJ members currently participate in one of Horizon BCBSNJ's patient-centered programs. For its 2014 results, Horizon BCBSNJ reviewed claims data for members receiving care from a patient-centered practice and compared those findings to members receiving care from traditional primary care practices.

The results found that patient-centered members, as compared to those members in traditional practices, had a:

  • 6 percent higher rate in improved diabetes control.
  • 7 percent higher rate in cholesterol management for diabetic patients.
  • 8 percent higher rate in colorectal cancer screenings.
  • 3 percent higher rate in breast cancer screenings.

The findings also show that more coordinated care is being provided at a lower cost, as Horizon BCBSNJ members in patient-centered practices had a:

  • 8 percent lower rate in hospital admissions.
  • 5 percent lower rate in emergency room visits.
  • 9 percent lower total cost of care.

"Patient-centered" care refers to an innovative approach where health insurance companies reward doctors for meeting certain clinical quality, patient satisfaction, and efficiency benchmarks. Unlike the traditional fee-for-service model, patient-centered practices are also financially rewarded to improve patient care based upon national clinical guidelines and also improve the patient experience with such things as extended hours and more active communication.

There are more than 6,000 network doctors in Horizon BCBSNJ's patient-centered programs. The patient-centered practices include doctors in Patient-Centered Medical Homes (PCMHs), Accountable Care Organizations (ACOs) and practices focused on Episodes of Care across New Jersey.

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.
Go to top