N.J. picks provider for direct primary care service

Elkins Park, Pennsylvania-based R-Health has been contracted by the state of New Jersey to provide a no-fee direct primary care service.It’s the largest contract for direct primary care service, with potentially more than half a million members of the New Jersey State Health Benefits Program and School Employees’ Health Benefits Program and their families, according to R-Health CEO Mason Reiner.

R-Health partners with local physicians to offer a different kind of value-based care model. Rather than focusing on traditional fee-for-service reimbursements, the doctors are incentivized to engage with patients when they are not in the office, Reiner said.

This helps reduce the overall cost of care for both the members, who pay no copay, and for the doctors, who are reimbursed for keeping patients well and out of expensive specialty visits.

This also helps doctors not worry about the number of patients they see per day and, instead, how well those patients are being cared for.

The pilot program is rolling out in three locations: Haddonfield, Moorestown and across the Delaware River in Washington Crossing, Pennsylvania. The company has plans to add new practices across the state, with a new location opening in the Trenton area in early 2017, according to a statement. 

For New Jersey’s plan, the two state plan administrators — Horizon Blue Cross Blue Shield of New Jersey and Aetna — were directed to design the network plan and rates based on the three locations participating.

“In the state of New Jersey, we are facing out of control health care cost increases and we knew we had to take a hard look at the various ways we could fix this,” Patrick Nowlan, executive director of Rutgers AAUP-AFT and chair of the SHBP Plan Design Committee, said in a statement. “After much research, we realized a core component of cost savings — and better patient experience — was more proactive and relationship-based primary care.”

The contract gives R-Health the largest program in the country, according to Mike LaPenna, owner of Michigan-based The La Penna Group.

Typically, school boards will engage in a joint venture with local municipal or county government bodies to create a health plan with direct primary care.

LaPenna sad this model is direct competition for hospitals, especially those who are hiring physicians.