New Jersey

In September, 2010 a state law (NJ P.L. 2010, Chapter 74) was passed directing Medicaid to establish a three-year pilot demonstration for medical homes focusing on the frail elderly and those with chronic diseases.  In response to the legislation, the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) wrote a Memorandum of Agreement (MOA) requesting that the four Medicaid contracted managed care organizations (MCOs) in NJ participate in a pilot to enhance or create infrastructure, within their networks, for medical home services.

New Jersey was selected to participate in a federal pilot that aims to transform primary care practices into patient-centered medical homes that cut costs and enhance care by eliminating duplicative and unnecessary treatments.

Horizon Blue Cross Blue Shield of New Jersey is transforming and improving New Jersey’s health care delivery system by collaborating and developing solutions to create a health care system marked by high-quality care, a better patient experience and improved affordability.

The joint program benefits approximately 10,000 individuals covered by a Cigna health plan who receive care from more than 300 Summit Medical Group providers. 

Under the program, Hunterdon Healthcare Partners monitors and coordinates all aspects of an individual's medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists.

Under the program, Atlantic ACO monitors and coordinates all aspects of an individual’s medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists.

The participating physician practices will monitor and coordinate all aspects of an individual's medical care. Patients will continue to go to their current physician and will not need to do anything to receive the benefits of the program. There also are no changes in any plan requirements regarding referrals to specialists. Patients most likely to see the immediate benefits of the program are those who need help managing chronic conditions, such as diabetes or heart disease.  

Cooper University Hospital in collaboration with the Camden Coalition of Healthcare Providers, serving Camden, New Jersey, and adjoining areas, is receiving an award to better serve approximately 600 patients with complex medical needs who have relied on emergency rooms and hospital admissions for care. The intervention will use care management and nurse led interdisciplinary outreach care teams to work with enrolled participants to reduce avoidable emergency room visits, inpatient hospital admissions, and hospital readmissions and improve their access to primary health care.

Developmental Disabilities Health Services is receiving an award to test a developmental disabilities health home model, using care management/primary care teams of nurse practitioners and MDs to improve the health and care of persons with developmental disabilities in important clinical areas.

[ENDED IN 2015] Each of the Aligning Forces 4 Quality (AF4Q) communities has built its initiative around a core, multi-stakeholder leadership alliance working to advance the goals and activities of AF4Q at the local level. These alliances include participation from physicians, nurses, patients, consumers and consumer groups, purchasers, hospitals, health plans, safety-net providers and others. Improving the quality of ambulatory care has been an area of focus for Aligning Forces for Quality since its inception.