Continuum’s Population Health Management Program Delivered a 17% Lower Cost of Care to Patients
A group of 23 internal medicine and family medicine practices with 27 locations throughout New Jersey, participated in a shared savings program with a commercial payor. The population of 20,000 consisted of adults over the age of 18. The goal of the program was to improve quality based on specific HEDIS Metrics, improve patient satisfaction and reduce the overall cost of care. The initiative required that all practices make a commitment to becoming a NCQA recognized Patient Centered Medical Home (PCMH) within two years.
Keys to Success
The program utilized a centralized and scalable model of coordinated care that included the services of RN’s, a social worker, a pharmacist and support staff. The program was affordable to practices of every size because of this centralized approach, and the care coordination was responsive to individual practices and patients. The interactions with patients ranged from telephone communication to, “Super Visits.” A Super Visit is used for patients with the greatest needs who benefit from bringing the entire care team, patient and family together to manage an individual’s specific healthcare needs.
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