This morning, we had the opportunity to speak with Dr. Richard Popiel, President and Chief Operating Officer at Horizon Healthcare Innovations, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), and spoke about just-released results on its patient-centered medical home (PCMH) program, which is New Jersey’s only comprehensive, statewide PCMH. The program now includes 152 physicians at 22 practices and will continue to expand throughout 2012.
Many of you are familiar with Kevin Maher and Dr. Tom McCarrick’s stories, which highlight how Horizon Healthcare Innovations collaborates with the primary care physician (PCP) offices in the PCMH program. The stories anecdotally relate the superior patient outcome and cost benefits resulting from the program through the voices of Helen Kuryllo, a patient advocate, and Dr. McCarrick of Vanguard Medical Group in Verona, New Jersey.
Horizon BCBSNJ’s PCMH program now covers more than 80,000 members, and the company is developing other accountable care delivery models. Horizon BCBSNJ’s early metrics prove that the PCMH model drives quality and cost improvements. In comparing preliminary 2011 quality and cost trends for 24,000 Horizon BCBSNJ members participating in the medical home with those who were not, quality, cost, and utilization indicators improved.
Patient engagement at the moments of care in the physician’s office is critical—and the PCMH model facilitates that communication. For example, in terms of quality measures, Dr. Popiel told us that there was an 8% higher rate in improved diabetes control (HbA1c). To show how significant that 8% is, consider that according to the U.S. Department of Health and Human Services, diabetes affects 25.8 million Americans, or 8.3% of the U.S. population. It was the seventh-leading cause of death in the United States in 2007. People with diabetes are at twice the risk of death of those of similar age who do not have the disease. Projections indicate that one in three people born in the United States in 2000 risks having diabetes at some point in their lives.
Likewise, the cost and utilization indicators clearly point to the success of the program. Among the indicators that Dr. Popiel discussed, we found the following to be particularly encouraging:
- 10% lower cost of care per member per month
- 26% lower rate in emergency room visits
- 21% lower rate in hospital inpatient admissions
- 25% lower rate in hospital readmissions.
We believe that a healthcare revolution in the United States is achievable through accountable care delivery models like the PCMH, which offers a collaborative, team-based approach with the PCP at its nexus. Horizon BCBSNJ’s results support this belief. Technology will connect all parties participating in this value-based, risk-sharing healthcare delivery model and enable them to use standard metrics to evaluate the quality of care across patient populations.
Stay tuned for more news on this exciting initiative. We appreciate Dr. Popiel taking the time to share these groundbreaking health and cost improvements with us. Join the discussion on our blog or by connecting with us on LinkedIn, Facebook,and Twitter. Learn more about what HIT experts and physicians are thinking about in 2012, including Dr. Geeta Nayyar of AT&T, Bryan Vartabedian of 33 Charts, Janice McCallum of Health Content Advisors, and Jennifer Dennard of Billian’s HealthData and Porter Research.
 Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF Lifetime risk for diabetes mellitus in the United States. JAMA. 2003;290:1884-90.