NJ Academy of Family Physicians/Horizon Blue Cross Blue Shield of NJ

The New Jersey Academy of Family Physicians (NJAFP) is collaborating with Horizon Blue Cross Blue Shield of New Jersey (Horizon) on a Patient-Centered Medical Home (PCMH) Pilot Project. During the first component of this project, NJAFP worked with practices by providing an educational curriculum and assistance to participating practices, in pursuit of national NCQA Physician Practice Connections®–Patient Centered Medical Home™ (PPC®-PCMH™) Recognition. NJAFP is pleased to announce 33 practices participating in the NJAFP/Horizon Pilot Project received national NCQA PPC-PCMH recognition. “This is a major accomplishment for the practices. The practices in our project worked with us and dedicated the time and resources needed to begin the journey of transforming their practices to this patient-centered care model. The hard work by everyone involved allowed the practices to achieve national PCMH recognition in about four months. Seven of the practices reached the highest NCQA recognition level, Level 3, which is amazing,” states Ray Saputelli, CAE, Executive Vice President, NJAFP.

The core goal of the project is to support primary care practices as they begin to transform traditional office-based care from an acute episodic care model to the PCMH model. Practices participated in an NJAFP-developed and -directed educational program, which focused on assisting them in demonstrating that they met nationally recognized NCQA PPC-PCMH standards. After achieving PPC-PCMH recognition, the Pilot Project practices moved into the quality metric and reporting component of the project. This component focuses on quality measurement reporting, implementing additional PCMH elements into practice and working to reduce healthcare costs. From October 2009 through September 2010, participating practices will report to Horizon on 13 quality measures, which include process and outcomes measures for diabetes, as well screenings for breast, colon, and cervical cancer, smoking cessation, and influenza vaccination. .

The NJAFP/Horizon Pilot Project is an opportunity, on a limited basis, to begin applying concepts and processes consistent with the PCMH model of care to a defined group of practices and patient population. During the next 12 months, practices in the project will be receiving a defined payment, or care coordination fee, from Horizon for their Horizon patients with diabetes. In addition, there is a potential for a cost savings sharing component for participating practices.