New Jersey Blues plan houses employees at practices

For some practices in New Jersey, the medical home will include an insurance company representative "living" there.

Horizon Blue Cross Blue Shield of New Jersey is paying for staff to work full time at medical offices participating in a patient-centered medical home pilot program.

The company said it will fund a full-time "population care coordinator" to each participating practice for the course of a two-year medical home pilot. That person will offer what Horizon called "clinical and administrative support," helping document care as required to earn quality-based pay and contacting patients about care.

The idea was based on feedback that the New Jersey Academy of Family Physicians received from primary care physicians who had participated in an earlier pilot, said Cari Miller, director of advocacy and program operations for the academy.

The academy and Horizon have been working together for the past three years to establish patient-centered medical homes throughout the state. Participating physicians' early feedback indicated that what they needed most were better reimbursement and more resources.

Ideally, Miller said, patient-centered medical homes would get extra pay from multiple plans, allowing them to hire their own staff. "That would be nirvana," she said. But short of that, having one health plan pay for an employee will be a big help, she added.

"What doctors really wanted was not more disease management programs, not more paper pamphlets but actual staff -- people in their offices," said Nicholas Bonvicino, MD, senior medical director and director of clinical initiatives at Horizon Healthcare Innovations, a subsidiary the Blues plan established to experiment with payment reform.

As of Jan. 18, when the patient-centered pilot was announced, 23 practices serving 24,000 Horizon members had signed on for the new pilot, and the insurer plans to add more this year.

Participating practices will be reimbursed as usual but have an opportunity to earn an "outcomes-based payment" after 12 months, Dr. Bonvicino said.

When the two years is up, the population care coordinator might be hired by the practice, or he or she might be "recycled" to another practice newly minted as a patient-centered medical home, Dr. Bonvicino said.

He said Horizon hopes to see 200 to 250 patient-centered medical homes throughout New Jersey.