Horizon Blue Cross Blue Shield of New Jersey and Medical Home Practices Selected for New Public-Private Initiative to Strengthen Primary Care

As Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) develops and expands its Patient-Centered Medical Home (PCMH) program throughout New Jersey, the company and thirty-seven current Horizon BCBSNJ PCMH practice locations were selected to participate in a landmark effort by the federal Centers for Medicare & Medicaid Services (CMS) to transform primary care on a national scale.

The goal of the new federal program, the Comprehensive Primary Care (CPC) Initiative, is to provide improved access to quality health care at lower costs. In April, CMS announced that it had chosen Horizon BCBSNJ to participate as a payer in New Jersey – one of seven markets selected for the program. CMS announced today the 73 primary care practice locations selected in New Jersey to participate in the CPC Initiative. To view CPC Initiative practices, click . Thirty-seven selected locations currently participate in Horizon BCBSNJ’s medical home program.

“Horizon is committed to transforming the way health care is delivered in New Jersey to improve quality and contain costs,” said Robert A. Marino, Chairman and CEO of Horizon BCBSNJ. “We’re looking forward to working with CMS, participating health plans and selected primary care practices in this initiative to strengthen our health care delivery system for New Jersey patients.”

“Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients,” said Acting CMS Administrator Marilyn Tavenner. “By engaging in this unprecedented and innovative public-private partnership we aim to create a payment model that allows our primary care practices to take a lead role in delivering improved overall coordinated care for their patients. Our goal is to see healthier families across our nation and to generate savings for providers, insurers and taxpayers.”

Under the CPC Initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating insurance plans, including Horizon BCBSNJ, are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members. Selected practices may have the opportunity to participate in Horizon BCBSNJ’s PCMH program, which includes financial support and other transformation resources to help practices deliver better care at lower costs.

“With early results showing that Horizon’s collaborative medical home program is improving the quality of care and reducing health care costs, we want more of our members to benefit from the program,” said Jim Albano, Vice President, Network Management and Horizon Healthcare Innovations, Horizon BCBSNJ. “With Horizon’s commitment to the CPC Initiative, we intend to have more than 200,000 members in Horizon’s medical home and accountable care programs by the end of 2012.”

Horizon BCBSNJ recently increased the number of members attributed to medical homes from 80,000 to 154,000. Forty-eight primary care practices at 145 locations are participating in this program. To view participating practices, click . This program will continue to expand this fall with Horizon BCBSNJ’s participation in the CPC Initiative.

About Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a tax-paying, not-for-profit health services corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving 3.6 million members with headquarters in Newark and offices in Wall, Mt. Laurel, and West Trenton. Learn more at .

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