BlueCross Medical Home Initiative Improves Quality with Innovative Clinical Technology

CHATTANOOGA, Tenn. — As part of its Patient-Centered Medical Home strategy, BlueCross BlueShield of Tennessee is partnering with local health care provider groups and hospitals to roll out technology designed to positively impact the quality of patient care once that person leaves the hospital. Holston Medical Group in Kingsport, TN, is the first to incorporate Smart Transitions from Performance Clinical Systems in its hospital discharge workflows.

Numerous benefits in patient safety have been achieved since the technology was introduced, including alerting primary care physicians in 18 percent of the cases that a new “high-risk” medication had been prescribed and in 24 percent of the cases that post-hospitalization tests were ordered requiring primary care physician follow up.

“With recent studies showing readmission rates as high as 20 percent within 30 days of leaving the hospital, and with our associated costs for these readmissions being as much as $60 million a year, we believe creating a link between inpatient and outpatient care teams is critical for improving outcomes and satisfaction for our members, as well as for those who pay the bill,” said Dr. Robert Mandel, senior vice president of health care services for BlueCross. “We aim to empower all participants in the transition of care workflow with an easily embraced solution that not only supports evidence-based medicine, but makes care related information accessible in a much more timely manner than traditional processes.”

Performance Clinical’s Smart Transitions is a “cloud-based” interactive clinical checklist system, accessible anywhere through a secure Internet connection, which provides active guidance for clinicians to consider as they make their patient discharge plans. The system makes those plans instantly available via a computer to primary care physicians for proactive follow up with their patients. All steps are captured electronically in a database for ongoing analysis to support quality and performance improvement goals.

“Creating a strong chain of care communication is vital for delivering the quality of care expected of our physicians,” said Dr. Scott Fowler, president of Holston Medical Group. “Typically, the enabling technology for facilitating this communication is met with resistance because of its complexities and disruption to clinical workflows. With Smart Transitions, we found the opposite to be true. Our hospitalists appreciate how easy it is to incorporate into their routine and our primary care physicians are already benefiting from the real-time access to comprehensive transition of care plans.”

“We’re delighted that BlueCross BlueShield of Tennessee turned to us to help them drive this important component of their Medical Home Initiative,” said Performance Clinical’s co-founder and chairman, Jeremy Nobel, M.D., M.P.H. “Our interactive clinical checklist system provides partnering medical groups, hospitals and primary care teams with the infrastructure for decision support, shared access to patient-specific plans, and performance analytics to drive improvement. This milestone with Holston Medical Group and BlueCross is a great example of a high-impact, yet practical solution that delivers on the promise of better patient care through health information technology.”

About Holston Medical Group

As one of the largest multi-specialty providers within the Southeast, Holston Medical Group’s “Family of Care” consists of more than 800 employees, including 150 physicians and mid-level providers in its provision of 24-hour medical/surgical coverage. Regarded as a national leader in clinical research as well as electronic health record integration and utilization, Holston Medical Group provides convenient locations throughout Northeast Tennessee and Southwest Virginia, offering two Urgent Care Clinics (Bristol & Kingsport) and state-of-the-art diagnostic capabilities. On-site ancillary services available include digital x-ray and mammography, CT, MRI, ultrasound and cardiac services. Additionally, HMG provides the patient convenience of on-site laboratory services. For more information, visit the group’s Web site at: www.holstonmedicalgroup.com

About Performance Clinical Systems

Performance Clinical Systems is a healthcare technology company based in San Francisco, California and Boston, Massachusetts. Christopher Johnson, MD, MPH and Jeremy Nobel, MD, MPH founded the privately held company in 2004. Its core applications, SmartOrders and SmartTransitions, inject precision and consistency to evidence-based medicine, provide interactive clinical checklists directly at the point of care, and gather essential data for advanced analytics and quality improvement. The company’s solutions are attractive to hospitals and medical groups because they are quickly embraced by clinicians, deployed rapidly (within 90 days) work alongside or as a layer on traditional enterprise HIT systems, and contribute significantly to a provider’s ability to handle shifts in reimbursement and quality measures that put the burden of efficiency on them. For more information, visit the company’s Web site at www.performanceclinical.com

About BlueCross

BlueCross BlueShield of Tennessee is the state’s oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans. BlueCross serves its members by delivering quality health care products, services and information. BlueCross BlueShield of Tennessee Inc. is an independent licensee of BlueCross BlueShield Association. For more information, visit the company’s Web site at www.bcbst.com.

CDPHP and MVP Health Care: Ellis Medicine Warrantees Cardiac Surgery

SCHENECTADY, NY – Through an unprecedented collaboration with CDPHP and MVP Health Care, Ellis Medicine is essentially guaranteeing the quality of its care. Under this unique program, if a patient undergoes coronary artery bypass (CABG) at Ellis and is readmitted to the hospital for related complications within 90 days of discharge, Ellis will share with CDPHP and MVP Health Care, in the responsibility for the hospital costs.
 
The overall goal of the warranty program is to enhance quality, standardize care and prevent patients from winding up back in the hospital.
 
“As a top 50 cardiovascular hospital we’ve demonstrated our expertise and we’re confident that our new quality initiatives will help us provide even better care,” said James W. Connolly, president and CEO, Ellis Medicine. “By putting our money where our awards are, we’re allowing our MVP Health Care and CDPHP patients to obtain both financial and clinical benefits from our good work. Our warranty says, ‘Our care is outstanding and we stand behind it’. It’s as simple as that.”
 
At the center of Ellis’ unique Cardiac Surgery Warranty is a series of new steps designed to enhance the quality of care for all patients – before, during and after cardiac surgery. They range from clinical checklists, pathways and patient compacts to a collaborative effort with organizations such as Visiting Nurse Service of Schenectady and Saratoga Counties to ensure a smooth transition of care.
 
“As evidenced by the successful restructuring of hospital care and the creation of the Medical Home in Schenectady — re-inventing health care, one patient at a time, begins right here at home,“ said Connolly. “We’re grateful to our health insurance partners, CDPHP and MVP Health Care, for working with us to develop creative ways to enhance quality, reduce health care costs and bring shared financial accountability to the process,” he added. “This is our joint commitment to health care reform.”
 
“CDPHP believes that higher quality actually drives costs down,” said John D. Bennett, MD, president and CEO, CDPHP. “An initiative such as this will boldly lay the groundwork to demonstrate a joint commitment to high-quality health care and a partnership for better health value to our members and the community-at-large. We laud Ellis Medicine for taking the lead on guaranteeing care, and are pleased to collaborate with them and MVP Health Care on fulfilling their vision.”
 
“What we’re announcing today is a way for doctors and hospitals to be paid appropriately for delivering the best care possible,” said David W. Oliker, MVP president and CEO. “I’ve said for many years that high quality care doesn’t necessarily mean high-cost care. In fact, high quality care is quite often less costly. This program to reduce readmissions is an excellent example of what I mean,” Oliker said.
 
Cardiology Associates of Schenectady is an integral part of the new warranty program. “As cardiologists, we’re committed to delivering the highest quality of care to our patients. As one of the nation’s top 50 cardiovascular hospitals, we’re proud of our entire cardiac team and we’re excited about this opportunity to support Ellis Medicine’s steadfast dedication to cardiac excellence,” said John Nolan MD, Chair, Cardiac Sciences, Ellis Medicine.
 
“As cardiac surgeons, we’re confident in the ability of our team to provide the safest, most skilled surgical care, said Herb Reich, M.D., Ellis’ Chief of Cardiothoracic Surgery. “Ellis is backing up the quality of its heart surgery with a warranty – that makes us even more proud of the work we do for our patients,” he added.
 
This unique program aligns quality initiatives with reimbursement. It places Ellis well ahead of the curve with regard to impending federal healthcare mandates that will penalize hospitals for costly readmissions. As part of the new federal standards, Ellis and other hospitals will get paid based on the quality of care that is delivered.
 
Ellis Medicine was recently recognized as one of the nation’s Top 50 Cardiovascular hospitals by Thomson Reuters, a global health research organization.

Humana Becomes Premier Sponsor Of Pro-Bicycling Campaign “Peopleforbikes.org”

BOULDER, Colo.–(BUSINESS WIRE)–Humana Inc. (NYSE: HUM), one of the nation’s largest publicly traded health and supplemental benefits companies, has become a premier sponsor of peopleforbikes.org, a nationwide pro-bicycling campaign. The campaign is an unprecedented effort to unite 1 million bicyclists of all riding styles and abilities to encourage government leaders to support cost-effective legislation that improves bike paths, lanes, trails and other facilities from coast to coast.

“We are thrilled to have Humana on board to sponsor our important mission of improving bicycling through our peopleforbikes.org campaign”

The backbone of the campaign, which was created by the nonprofit Bikes Belong Foundation, is a pledge in support of safer bicycling in the U.S. The campaign, which launched in 2010, has already generated more than 175,000 pledges toward its 1 million goal.

Humana’s sponsorship will allow the campaign to grow in 2011, with broader reach in advertising, public relations, social media, at events, and through in-store promotion at bicycle retailers.

“At Humana, we are committed to supporting programs that result in healthier lifestyles and healthier communities,” said Raja Rajamannar, Humana’s chief innovation and marketing officer. “Bicycling is one of the simplest ways to help solve some of our nation’s most pressing problems, including serious public health crises such as the obesity epidemic. By supporting the peopleforbikes.org campaign for better bicycling in our country, Humana is taking the latest in a series of steps designed to make healthy things fun and fun things healthy.”

“We are thrilled to have Humana on board to sponsor our important mission of improving bicycling through our peopleforbikes.org campaign,” said Bruno Maier, vice president of Bikes Belong. “As our leaders plan for the future of transportation and recreation in America, we need to send a unified message that bicycling is important and beneficial to individuals and our nation. Humana’s support will enhance our ability to do this.”

Bikes Belong and Humana first teamed in 2008, when they took 1,000 bicycles to the national U.S. political conventions in Denver and Minneapolis-St. Paul. The “Freewheelin” campaign was a huge success, with riders from all 50 states, Washington D.C., and 37 countries taking more than 7,500 free bike rides, pedaling more than 41,000 miles, burning 1.3 million calories and reducing their carbon footprint by 14.6 metric tons.

About Bikes Belong

The Bikes Belong Foundation, host to the peopleforbikes.org campaign, focuses on improving bicycle safety and enhancing children’s bike programs. The Foundation is the charitable arm of the Bikes Belong Coalition – the U.S. bicycle industry organization dedicated to getting more people riding bikes more often. Bikes Belong Coalition works to increase federal bike funding, awards grants to support innovative bike projects, promotes bicycling and its benefits, and backs crucial national efforts such as Safe Routes to School, Bicycle Friendly Communities, and the National Bike Summit.

About Humana

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.1 million medical members, 7.0 million specialty members, and operates more than 300 medical centers and 240 worksite medical facilities.

Humana is a full-service benefits and well-being solutions company, offering a wide array of health, pharmacy and supplemental benefit plans for employer groups, government programs and individuals, as well as primary and workplace care through its medical centers and worksite medical facilities.

Highmark Recruits Nurse Practitioners as Primary-Care Providers

Jan. 19, 2011 | Camp Hill, Pa. In order to give Highmark members more health care options, Highmark is working with certified registered nurse practitioners (CRNPs) to expand their role to serve Highmark members in much the same capacity as a primary care physician (PCP).

“The health care reform legislation that was passed earlier this year will likely mean more people will be getting health care coverage and seeking health care services,” said Carey Vinson, M.D., Highmark’s vice president of quality and medical performance management. “By recognizing CRNPs’ ability to work up to the full scope of their medical license, it will allow greater access for members.”

Highmark is reaching out to several hundred CRNPs across Pennsylvania to determine if they would like the designation to serve Highmark members as a network primary care CRNP.

Currently, Highmark works with CRNPs primarily in two ways. The CRNP may work with a physician now and are not credentialed. They typically work closely with a physician in a primary care or family practice setting or they may work for a specialist. The second area where Highmark engages CRNPs is when they function independently. They do, however, collaborate with physicians in the Highmark network, even when working independently.

A CRNP’s duties may often include diagnosing, treating, evaluating and managing chronic disease. Their duties also could include ordering routine tests and prescribing medication.

“During the next few months, we will see just how many of the CRNPs choose to apply for this designation,” said Vinson. “Over time, we believe this is another way to make the state more attractive to CRNPs.” Highmark is also making various CRNP training programs aware of this change.

Dr. Vinson also noted that in many cases CRNPs work in a retail clinic setting, something Highmark supports. These clinics have proven to be cost efficient and very convenient for members.

About Highmark Inc.
As one of the leading health insurers in Pennsylvania, Highmark Inc.’s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.7 million people through the company’s health care benefits business. Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people’s health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark’s positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For more information, visit www.highmark.com.

Blue Cross and Blue Shield of Kansas City Has an App for That!

Kansas City, MO (January 13, 2011) – Blue Cross and Blue Shield of Kansas City is making it easier for its customers to find a doctor or medical office on the fly with its new iPhone app. This innovative app – Provider Look Up – will help Blue Cross and Blue Shield of Kansas City customers quickly and easily locate any provider or facility, including urgent care facilities, in the Blue KC network from their iPhone, iPod Touch and iPad. The app leverages a customer’s location to help them find a doctor that is close by, and tells them if he or she is accepting new patients – real-time information at their fingertips. 

“We’re very excited about our new iPhone app,” said David Gentile, President and Chief Executive Officer, Blue Cross and Blue Shield of Kansas City. “This app marks just one of many upcoming initiatives we have in the works to help us better serve our customers by offering convenience and information at their fingertips. Our goal is to be there for our customers when they need us, and this app extends that reach further than ever before.”

Kevin Sparks, Group Executive for Blue Cross and Blue Shield of Kansas City, continued, “We’re working on a comprehensive mobile strategy that will ultimately optimize key elements of our website, making it even easier for our customers and customers-to-be to get the information they need, when they need it.”

The new Provider Look Up is free, and rates from your wireless service provider do apply. Provider Look Up, which can be downloaded from the App Store, is the first of several technological innovations Blue Cross and Blue Shield of Kansas City will launch.

About Blue Cross and Blue Shield of Kansas City

Blue Cross and Blue Shield of Kansas City, the largest not-for-profit health insurer in the state and the only not-for-profit health insurer in Kansas City, has been part of the Kansas City community since 1938. Blue Cross and Blue Shield of Kansas City provides health coverage to nearly one million residents in the greater Kansas City area and Northwest Missouri. Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross and Blue Shield Association.

Coventry Health Care of Florida Launches Innovative Health Care Plans

TAMPA, Fla., Jan 11, 2011 (BUSINESS WIRE) — Coventry Health Care of Florida (NYSE: CVH) is first to the greater Tampa market with a portfolio of hybrid PPO (preferred provider organization) health care plans that blend the best features of traditional co-pay based plans with the freedom and affordability of consumer-directed plans. Coventry’s Sunny Joe products are the only health plans in the Tampa area with true out-of-pocket maximum amounts, which include the annual deductible and all medical and prescription drug co-pays. Available to employer groups in Hillsborough, Pinellas, Pasco and Hernando counties, Sunny Joe health care plans provide comprehensive benefits for the employee at a much lower price point for the employer group. 

The health plans are ideal for the company that is searching for a product that combines low premiums with reasonable cost-sharing for employees, which is then offset with co-pays for health care services that are typically used the most. There are four Sunny Joe health care plans available with varying deductible levels ($1,500, $2,000, $3,000 and $5,000) and co-pays starting as low as $3 for tier-one generic drugs and $35 for primary care office visits.

According to Families USA, less than half of employers with fewer than 50 employees offer health care plans. “Many companies would like to offer health insurance to their employees but simply can not afford what’s available in the market,” explains Christopher Ciano, chief executive officer for Coventry Health Care of Florida. “We are now offering companies a viable and affordable solution for health care.”

The launch of the Sunny Joe product portfolio is one component of the company’s strategy for membership growth in Florida. As a result of health care reform, Coventry Health Care of Florida’s main segments of focus, for this year, are small and medium size employer groups, as well as the individual market. In addition, Medicare Advantage and Managed Medicaid will continue to be an important segment for growth. For more information or to receive a quote for a Sunny Joe plan, call 1-866-576-1094.

Coventry Health Care of Florida offers individuals and employer groups a full range of health care plans and products to choose from including HMO, POS, PPO, Open Access, Consumer Driven, Medicare, Medicaid, Healthy Kids and Long Term Care. More than 400,000 Floridians and 7,500 employers depend on Coventry for their health care needs. For more information, visit chcflorida.com.

Nationally, Coventry Health Care is a publicly traded (NYSE: CVH), Fortune 500 company that serves more than 5 million members in all 50 states.

SOURCE: Coventry Health Care of Florida

BCBSNC, UNC Health Care Announce Partnership To Launch Novel Patient-Centered Practice

CHAPEL HILL – The state’s leading health insurer and the state’s health care system will collaborate to develop a completely new type of medical practice in which patients – not just their symptoms – are the focus of care. This advanced medical practice will extend beyond what is currently called the ‘medical home’ and will enable teams of health care providers to work collaboratively with patients and families in delivering high quality, coordinated care. BCBSNC and UNC Health Care expect the new practice, which will likely be located in Orange or Durham county, to open in the fourth quarter of 2011.

This venture would be the first product of what BCBSNC and UNC Health Care expect will be an ongoing collaboration in which they work together to enhance health care quality, improve efficiency and effectiveness, and reduce healthcare costs.

“The team approach to care emphasizes patient involvement and allows more time for clinical interaction and patient education and support,” said BCBSNC President and CEO Brad Wilson. “We believe this approach will result in improved health and fewer complications – both of which will help control rising health care costs.”

“We’re in an era of change in health care, so let’s work together to make positive change,” said Dr. William L. Roper, CEO of UNC Health Care.  “This innovative approach with education, patient support and self-management is one important step toward making health care less mysterious and more effective.”

The practice will care for 5,000 BCBSNC members focusing on patients with chronic conditions, including coronary artery disease, hypertension, diabetes, obstructive lung disease, major depression, and asthma. 

The new practice will provide continuity by coordinating care across a variety of settings and provider types. The practice is designed to enable more effective patient-provider interactions, which should result in better patient satisfaction and improved health. Additionally, this practice will provide an expanded set of services and greatly enhanced access to these services including:

  • Non-traditional visit formats (e-visits, televisits, home monitoring)
  • On-site mental health
  • On-site nutritionist
  • On-site pharmacy and medication management
  • On-site laboratory
  • Case management and coordination of care for patients requiring hospitalization
  • Group and educational visits
  • Extended weekday and weekend hours
  • State-of-the-art information technology

About BCBSNC: 
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 77 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at http://www.bcbsnc.com.

About UNC Health Care:
The UNC Health Care System is a not-for-profit integrated health care system owned by the state of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. UNC Health Care is comprised of UNC Hospitals, ranked consistently among the best medical centers in the country; the UNC School of Medicine, a nationally eminent research institution; community practices; home health and hospice services in seven central North Carolina counties; and Rex Healthcare and its provider network in Wake County. Although this new practice will only provide care for BCBSNC members, UNC Health Care’s other physician offices, hospitals and facilities will continue to provide care for patients with all types of insurance and those without insurance.

HealthPartners Announces Performance Bonuses for Providers

BLOOMINGTON, Minn.–(BUSINESS WIRE)–HealthPartners today announced that primary and specialty care groups earned more than $700,000 for meeting quality measures on care and patient satisfaction. The bonuses are part of the pay-for-performance program which will pay out a total of $28.4 million for goals met in 2009. That’s a significant increase from last year, when the program paid out more than $25.3 million for goals met in 2008.

The bonuses recognize excellent and superior care for primary care (large and small groups) and pediatric care, as well as several specialty areas, including cardiology, OB/GYN, physical therapy, behavioral health and ENT. Pharmacies were also rated.

“We’re always happy to pay these bonuses because it means patients are getting better care,” said Babette Apland, HealthPartners senior vice president for health and care management.

HealthPartners Partners in Quality program was introduced in 1997. It rewards providers in practices throughout Minnesota and bordering states. The measures are based on guidelines developed by the Institute for Clinical Systems Improvement which represents more than 7,500 physicians in Minnesota.

About HealthPartners
Founded in 1957, the HealthPartners (www.healthpartners.com) family of health care companies serves more than one million medical and dental health plan members nationwide. It is the largest consumer-governed, nonprofit health care organization in the nation providing care, coverage, research and education to improve the health of members, patients and the community. HealthPartners is the top-ranked commercial health plan in Minnesota and is also ranked 19th in the nation according to NCQA’s Health Insurance Plan Rankings 2010-11 – private.

Blue Cross and Blue Shield of Tennessee Joins Forces with HealthCompare to Make Healthcare More Accessible

ORANGE, Calif.–(BUSINESS WIRE)–Blue Cross and Blue Shield of Tennessee, the state’s oldest and largest not-for-profit health plan with nearly three million members, announced today that it is partnering with HealthCompare to help individuals and families easily research, compare, buy and enroll in the right health insurance plan at the right price. HealthCompare (www.healthcompare.com) is one of the nation’s leaders in offering individuals shopping for health insurance free, accurate and customized health insurance quotes and personal assistance.

“PersonalBlue is aimed at helping consumers navigate the complex and often confusing world of individual health insurance,” said Charlie Goe, business segment director of individual sales. “The beauty of this product is that it breaks down the health insurance shopping process into smaller, less intimidating chunks. HealthCompare will greatly support this product by helping Tennesseans understand their options and select the right plan for themselves and their families.”

Using proprietary technology, HealthCompare presents easy-to-understand information on HMO, PPO and indemnity health plans so people have the tools and materials they need to make the most informed decisions. In Tennessee, users can now simply enter their information and receive instant quotes online based on Blue Cross and Blue Shield’s local offerings and provider network.

HealthCompare, a Word & Brown Company, was developed in late 2009 to help individuals and families easily research, compare, buy and enroll in the right health insurance plan at the right price online. Working closely with brokers and national insurance companies, HealthCompare offers individuals free, accurate and customized health insurance quotes and personal assistance in finding and selecting the right program to fit their needs.

Headquartered in Orange, California, The Word & Brown Companies is the nation’s recognized leader in developing and offering innovative technology, health benefit plan models, and sophisticated employee benefits services to companies of all sizes. In addition to HealthCompare, The Word & Brown Companies include CHOICE Administrators®, the nation’s only private health insurance exchange administering healthcare programs for more than 10,000 employers covering as many as 150,000 members; CONEXIS, the nation’s oldest and most trusted employee benefits administrator, providing COBRA/HIPAA, FSA, commuter benefits and direct bill services to thousands of clients nationwide; and Quotit® Corporation, the leading Internet application service provider for the health insurance and employee benefits industry. For more information, visit www.thewordandbrowncompanies.com.

Congestive Heart Failure Patients Receive Care Without Leaving Their Homes

(Newark, NJ, January 12, 2011) – What happens when high-quality medical care meets state-of-the art communications technology? Patients – even those with a serious chronic disease – can get the clinical attention they need right from their homes, when they need it, resulting in healthier outcomes and fewer visits to the hospital.

That’s what Horizon Blue Cross Blue Shield of New Jersey is seeking to achieve through a new pilot program for Congestive Heart Failure patients.  Using telemonitoring technology, medical professionals carefully observe and evaluate Horizon BCBSNJ patients remotely so they do not have to leave their homes.  

“Although congestive heart failure is a serious, chronic disease, its symptoms – such as shortness of breath and sudden weight gain – can be managed effectively, and often without a patient’s abrupt visit or re-admission to the hospital,” said Patricia Orchard, RN,  Director of Clinical Operations, Health Affairs, Horizon BCBSNJ.  “Under our pilot program, telemonitoring equipment, set up right in a patient’s home, detects warning signs to heart failure conditions, then sends an alert to the patient’s primary physician when warranted and a registered nurse from Horizon BCBSNJ.  With this early detection system in place, medical professionals can take immediate steps to intervene and prescribe the best setting and course of care for that patient,” Orchard said.

Telemonitoring is gaining wide acceptance among patients as an effective means of managing chronic diseases. A 2007 study by the Journal of American Medical Informatics Association found that home telemonitoring of chronic diseases “empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions.”

Facilitated by the Horizon BCBSNJ Clinical Operations Teams, the Congestive Heart Failure (CHF) Pilot targets 100 members who were determined to meet clinical criteria.  The three-month pilot began November 2010 and will be evaluated in February.

The primary diagnostic device used in the pilot is a scale, provided through Dayton, Ohio-based Valued Relationships, Inc. (VRI), which is tied to the in-home monitoring system and detects the weight gains symptomatic of congestive heart failure.

“This technology will promote better communication between patients and their physicians, reduce patients’ discomfort and anxiety by caring for them in their homes, and allow physicians and Horizon to assist patients better manage their own health,” Orchard added.

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 not-for-profit health services corporation.  Horizon BCBSNJ serves approximately 3.6 million members and is headquartered in Newark with offices in Wall, Mt. Laurel, and West Trenton.