NJ Hopes to Pilot ‘Multi-Payer’ Coordinated Care Initiative

Beth Fitzgerald | February 29, 2012 | Health Care
Program would pair Medicare and commercial insurers, helping doctors fund medical homes

New Jersey could be among a handful of states chosen in March to participate in an innovative pilot that will partner Medicare and private insurers in a coordinated model for healthcare. The Medicare initiative will increase the payments made to primary care practices so they can set up “medical homes” that coordinate patient care, makes sure preventive screenings are performed, and cut down on hospital readmissions.

“A pilot such as this, where you actually have Medicare in a pilot with the commercial payers, is huge for the [primary care] practices,” said Dr. Lisa Blondin, senior medical director for AmeriHealth NJ.

AmeriHealth NJ has applied to be part of a multi-payer pilot in New Jersey.

Five to seven healthcare markets will be selected to carry out the multiyear pilot, Blondin said. It’s a competitive process being overseen by the Centers for Medicare and Medicaid Services (CMS), with close to 40 applications under consideration.

If New Jersey is among the winners, CMS will designate 75 primary care practices to receive the additional reimbursements to provide coordinated care to patients in their practice — those covered by Medicare, and those covered by private insurance.

CMS wants to work with the commercial insurers to help primary care practices transform their care delivery model into what will essentially be a “patient-centered medical home,” Blondin said.

The providers will receive a per-patient, monthly fee to cover the medical home services, which will require physicians to spend more time with their patients and hire additional support staff, such as nurse coordinators who manage the care patients receive from specialists and primary care clinicians, Blondin said.

The idea is that better primary care yields healthier patients, which eventually will save Medicare money. Blondin said the pilot is a shared-savings model: “After the first few years CMS is going to look at the region and calculate savings, and then they will share those savings with practices that have met certain quality benchmarks.”

Medicare and the commercial payers will be working together to “agree on a methodology” on how to change the ways practices in the selected regions deliver care, she said. The idea is to have all the payers involved — so that all the payers are funding the medical home services, and the patients all receive the same, higher level of care, regardless of who is paying the bills.

“The more payers that are involved, the easier it is for the doctors to change what they are doing for the patients — because they are being paid to do the same things for all the patients,” Blondin said.

If New Jersey is selected, it will boost the state’s primary care practice environment, generally agreed to be suffering a physician shortage.

“I am a primary care physician and I trained in New Jersey, and primary care in New Jersey is an area that has not received a lot of attention,” Blondin said. “But what you do have in New Jersey are primary care physicians who are very dedicated to practice transformation and dedicated to the cause of improving the way a primary care practice functions, in order to really increase the value to the patients.”

This story has been modified from the original, which indicated that AmeriHealth was participating in “multi-payer” pilots in several regions of the country. Only AmeriHealth NJ is participating in a pilot in NJ.