Horizon, Optimus join forces on accountable-care organization

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Under the new ACO, 104 primary-care physicians and 42 physician practices throughout 11 New Jersey counties will operate as patient-centered medical homes.

Physician-run accountable-care organization Optimus Healthcare Partners LLC has launched a new ACO with Horizon Blue Cross Blue Shield of New Jersey in a bid to reduce medical costs and improve care for more than 40,000 Horizon members.

“We are looking for ACO partners that share our philosophy with creating a patient-centered medical home dominated marketplace, and a system like Optimus has a whole portfolio of specialists and primary-care doctors working towards that goal,” Horizon ACO director Joe O’Hara said. “Our care management services are powerful, but they’re not as powerful as a physician working directly with a patient.”

Under the new ACO, 104 primary-care physicians and 42 physician practices throughout 11 New Jersey counties will operate as patient-centered medical homes — a model Horizon has implemented since 2011 through its Horizon Healthcare Innovations subsidiary. Unlike the traditional payment relationship between provider and insurer, O’Hara said Horizon will provide incentive payments to Optimus physicians who manage patients’ chronic diseases over time, instead of treating symptoms as they appear.

Accountable-care organizations represent a new approach to health care delivery that seeks to coordinate medical care, engage patients in their own wellness, and improve health and control costs.

“This is a very important type of relationship between the biggest payer in the region and a large physicians group. It’s the marker for how we physicians are doing contracting with insurance companies in the future,” said Dr. David Shulkin, president of Morristown Medical Center, who is one of two Atlantic Health System executives on the Optimus board of directors. “If payers and providers in the state still thought nothing’s going to change, I would be a lot more worried than I am now.”

But Shulkin said Optimus, Horizon and partner hospital group Atlantic Health recognize “there’s not one single answer to how to improve health care, and not everything in these ACO models revolve solely around patient-centered medical homes.”

“I’m not convinced every doctor needs to change the way they practice in this exact way,” Shulkin said. “Physicians who do transform their practices into patient-centered medical homes have to start doing certain activities that they traditionally haven’t done, like embracing electronic medical records and taking responsibility for much broader health activities with their patients. These are all important steps to improving the quality of care in the region through physician practices … but we’ll need to establish different approaches with every doctor. This is not something you can turn on and off with a switch.”

O’Hara said Horizon will try to partner with each primary-care physician and practice to migrate to the patient-centered medical home model, because “sometimes, there are 14 physicians in one site, and other times, there are three sites with two physicians at each site, and they all have very different ways in how they engage with their patients.”

While the four independent physicians groups that make up Optimus already coordinate care in an ACO designed for the Medicare shared savings program, Shulkin said Horizon’s model is “not as restrictive for doctors.”

“In the Medicare model, it has to be the same for everyone who participates in the shared savings program around the entire country. There’s just not a lot of flexibility,” Shulkin said. “With the Horizon contract, physicians will have the ability to be more adaptive and customized to the needs of particular patients.”