Lower medical costs, fewer trips to the emergency room, more cancer screenings — those are some of the results so far of a collaboration between Horizon Blue Cross Blue Shield of New Jersey and Continuum Health Alliance, a Marlton firm that helps physicians improve their clinical and financial performance.
Horizon and Continuum launched their program in 2012 to focus on better care and lower costs for 20,000 Horizon members who are patients of Advocare, one of the largest doctor practices in New Jersey; Continuum provides practice management services to Advocare.
The program’s first year, which ended June 30, 2013, saw the cost of care decline 13 percent; ER visits were down 3.2 percent; hospital admissions fell 12.5 percent. The percentage of patients readmitted to the hospital within 30 days of discharge fell to 12 percent, compared with 18 to 20 percent for a comparable population. And the program hit the 90th percentile for care quality.
Progress has continued on the cost and quality fronts in the program’s second year, which ended June 30, 2014; those results will be released once all the data is compiled.
Dr. Steven R. Peskin, senior medical director for clinical innovations at Horizon, said, “Our ability to work collaboratively is what has really made the difference.” A critical component of the collaboration is sharing data: Horizon provides claims data and Continuum contributes electronic health record data from the patients, showing the medical care they’re getting, and how it’s impacting their health.
“Another important part of it from Horizon’s standpoint is to reward value over volume,” Peskin said. The physician practices receive extra payments from Horizon to cover the cost of providing the extra services required to coordinate the patient’s medical care and make sure they are getting the right preventive care.
“To be able to compensate great clinical organizations like Advocare and Continuum is a critical part of this,” Peskin said.
On average, Advocare receives an upfront payment of $5 per patient per month from Horizon. And the physicians receive shared savings distributions from Horizon for meeting the program’s goals.
Continuum President Christopher Olivia said a key has been Horizon’s commitment to getting the health care system to focus on both medicine and money.
“While their goal is to help their client base save money, they also understand that improving the health of the individual and the population served is equally as important as bending the cost curve,” Olivia said.
Figuring out how to get more people screened for colon cancer has been a key victory. Colonoscopies are recommended for those over 50, but nationwide only about half the population has had the test.
So the Advocare physicians worked on getting patients to instead take the FIT test, a simple stool-sample screening. That intervention got many more patients tested — and identified about 15 colon cancer cases.
“Think about all the money that was saved by treating those cancers in the early stage,” Olivia said. “Then forget that and think about this: Think about the improvement in the lives of those 15 people, how much better off they are. And that is really why people sign up for Horizon health insurance — they want to be healthy.”
Peskin said achieving a better colon cancer screening rate reflects the efforts of care coordination “working behind the scenes to identify patients who had not been screened. This is an example of a systematic change” in health care.
Continuum is one of many patient-centered health care collaborations that Horizon has forged across the state in the past few years. Horizon said about 500,000 of its members now get their care from patient-centered practices.
Peskin said its work with Continuum and others “is redefining the way health care is coordinated and organized so you get better outcomes” by focusing more on “wellness care versus sickness care.”
Olivia explained that patient-centered care includes the work of the non-clinical office staff, who keep tabs on patients; for example, making sure all the diabetics receive the screenings and routine care required to keep their disease under control.
“A very important person in the process can be the front desk person who is very good at communicating and is very passionate about taking care of patients,” he said. These individuals are not clinicians, “but they are empowered to get things accomplished, and they may have to hound the patients a little bit to get it done.”
The care coordinators, generally nurses, “work with the really complex, 5 percent of the patients who drive 47 percent of the cost. They work on the cases that are at risk for hospitalization. They help patients navigate the system, and get them out of the emergency department.”
He said, “When you put these things together, you have a level of service and a level of attention that patients don’t typically get in an average medical office.”
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