Horizon to offer lower-cost, patient-centered plans

Financial incentives for patients to visit particular doctors are expected to become increasingly prevalent.
Financial incentives for patients to visit particular doctors are expected to become increasingly prevalent. (Bloomberg)
Posted: June 14, 2014

Horizon Blue Cross Blue Shield of New Jersey will start selling two new health insurance plans for small businesses in July, with lower premiums and lower out-of-pocket costs if patients go to certain doctors, the Newark company said Thursday.

When participants in the plans go to doctors who participate in a program that pays them more when they improve patient satisfaction and patient care, the patients will save money. Under the traditional model of care, doctors get paid more by providing more services.

The financial incentives for patients to visit particular doctors are significant, and are expected to become increasingly prevalent in the health-care industry.

Premiums on the new plans are 15 percent less than comparable plans that do not include incentives to go to particular doctors. Deductibles of $2,500 and $2,000, depending on the plan, do not apply. The only out-of-pocket cost is a copayment of $40 or $20, again depending on the plan.

"Other health-insurance companies have been talking about patient-centered care and lower costs, but Horizon has collaborated to build the largest network of patient-centered practices across New Jersey and, as a result of improved care and lower costs, we are now offering small employers lower premium plans," said Christopher M. Lepre, senior vice president of market business units at Horizon.

A Horizon spokesman said he could not provide specific examples because dollar amounts will vary widely, depending on the size and makeup of an employer's workforce.

Horizon said there are more than 3,700 doctors at more than 900 locations in New Jersey that will offer lower costs for patients and employers in the new insurance plans.

In 2012, Horizon members in these so-called patient-centered medical homes - and that is the term for these medical practices - had a 23 percent lower rate of hospital admissions and 12 percent fewer emergency room visits than members not in patient-centered practices, Horizon said.

By the end of this year, 750,000 of Horizon's members will be using a patient-centered practice, Horizon said. At the end of 2013, Horizon had 3.69 million members, including 370,000 in small employers' coverage plans, its annual report said.

A South Jersey primary care physician said Horizon's approach makes sense.

"I believe this is a much better way to practice medicine. It is a patient-driven insurance," said Sloan Robinson, of Meetinghouse Family Physicians, a practice in Marlton that is part of the Horizon patient-centered program.


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