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NEW JERSEY Pilot Project – Direct Primary Care Medical Homes (voluntary)

***Health Benefit Changes***
State Health Benefits Plan | NEW JERSEY
Fall 2015 and January 2016

Moderate  Premium Increases —  on average rates will increase by 4.5% for state employees and 6.0% for local government workers though the actual premiums for family and employee/child coverage will increase more than single and employee/spouse/partner coverage.

Pilot Project  – Direct Primary Care Medical Homes (voluntary) — union members,  early retirees, and family members in any non-HMO plan can join this new pilot program any time during the year.  It features no copays for members and dependents and 24/7 access to a physician.

The patient load for doctors will be reduced from the typical level of 2500 patients per doctor to less than a 1000 per doctor allowing for much more regular interaction between patient and doctor, especially allowing doctors to provide more help to those with chronic conditions.

It is anticipated that these intensive primary care efforts will keep members healthier, improve the quality of healthcare, and produce significant savings by reducing the need for specialist referrals, ER visits, and hospital admissions.

The pilot will operate for three years with a goal of 60,000 members participating among south, central and northern pilots.   The quality and cost of the pilot will be evaluated by an independent group with the option to expand the effort if it is successful.

This initiative is believed to improve health quality and achieve both immediate and long-term savings for members.

Participation by members in the pilot is entirely voluntary and the member retains the ability to visit any specialist or facility while participating in the pilot.  The pilot starts on April 1, 2016.


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