Standing between a tide of rising of health care costs and increased regulatory and public sensitivity to premium increases, health insurers are not in an enviable position.

One payer, Horizon Blue Cross Blue Shield of New Jersey, has birthed a new company, Horizon Healthcare Innovations (HHI), which is dedicated to fomenting a paradigm shift that results in a health care system that delivers better care at dramatically lower costs.

Armed with $40 million funding for its first year, HHI is collaborating with physicians, hospitals, nurses to make the accountable care organization model viable in New Jersey. A large part of HHI’s endeavors revolve around strengthening primary care practices in the state. “Primary care in New Jersey is in crisis,” Kevin Maher, director, clinical innovation, told attendees this week at a roundtable discussion at the recent HIMSS12 Conference in Las Vegas. 

One innovation is the patient-centered medical home (PCMH) model, which eschews the entrenched fee-for-service-model and instead compensates participating primary care physicians for the comprehensive care management of their patients. HHI furnishes participating providers, many of which are financially strapped, with the technical and human wherewithal to make the transition to holistic healthcare. “We knew that if we didn’t provide the right type of resources the model would fail,” Maher said.

The PCMH model places population care coordinators within the practices. The care coordinators work with both the doctors and the patients to identify high-risk members and potential gaps in care. This coordinated approach ensures that patients get healthy and stay engaged in their health care. Patients thus avoid falling into the white spaces in the health care system.

The challenges to implementing this model are many, Maher says, including finding the right talent and onboarding new practices. There are also technology challenges, many stemming from a lack of standards and the need for better tools to extract data from EHRs. “A lot of work needs to be done around the area of data exchange,” he says. “We need the right technology to scale this.”

This story originally appeared on Insurance Networking News, a sister publication to Health Data Management.

 

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