Horizon/Mercy Programs Profiled in Best Practices Report on Medicaid Managed Care

TRENTON, N.J., March 28, 2002 —

Horizon/Mercy is featured in a national report, Innovations in Medicaid Managed Care: Health Plan Programs to Improve the Health and Well-Being of Medicaid Beneficiaries, recently issued by the American Association of Health Plans (AAHP). The report focuses on how health plans are successfully delivering excellent care to formerly underserved populations.

Five Horizon/Mercy programs are profiled in the report: the Asthma Relief Program; the Mom's GEMS (Getting Early Maternity Services) Prenatal Program; the Care Coordination Unit (CCU); the CHAMPS Program (pediatric preventive health); and a program using an inventive case management approach to decrease inpatient admissions for congestive heart failure.

"We are proud that our commitment to innovation and the results we have achieved for our members has allowed us to be recognized by the AAHP," said Velvet Miller, Ph.D., president and chief executive officer of Horizon/Mercy. "We hope that our initiatives will offer examples for other plans to adopt or adapt in order to better meet the needs of the populations they serve."

Horizon/Mercy's Asthma Relief Program is featured in the report for its improved use of medication therapy, assessment and improvement of home environment, and original patient and physician education strategies. These and additional disease management techniques helped to decrease by 15.2 percent the number of asthma inpatient admissions for members over six years of age since the program's inception in 1997.

"Visiting members' homes, identifying and eliminating factors contributing to asthma, and educating members about asthma trigger reduction in the home has helped us to significantly reduce the number of asthma attacks among members," says Barbara Mussell, director of quality/health management of Horizon/Mercy. "We also review members' lifestyles to determine and eliminate activities, such as smoking, that could be contributing to increased asthma attacks. When these practices are combined with medication, individual treatment plans, and education, excellent results can be achieved."

By providing pregnant members with resourceful case managers, incentives for keeping regular appointments, and comprehensive healthcare services, Horizon/Mercy's Mom's GEMS Prenatal Program achieved a significant reduction in neonatal intensive care unit lengths of stay and an extremely low incidence of low birth weight infants. The AAHP report highlights the program's assessment of each pregnancy with regard to risk factors such as drug and alcohol use and socioeconomic barriers to care, and its provision of specially trained obstetrical nurses and case management services support.

"Many of our members are 'at-risk," with pressing issues facing them, such as finding a place to live and putting food on the table. Prenatal doctor visits were getting put off due to these and other family stresses," says Pamela Persichilli, director of clinical operations of Horizon/Mercy. "In addition, some of our expectant mothers are so busy caring for their families that they do not have time to read complicated medical literature, and some need help with basic necessities. The GEMS program aims to fill the needs of this specific segment of the population."

Horizon/Mercy's Care Coordination Unit is profiled for its development and use of individualized care plans for members with special needs. The plans are created based on the recommendations of patients' primary care providers and the integration of appropriate specialized healthcare, social, and mental health services available through state and community-based agencies.

Through its CHAMPS Program, Horizon/Mercy has achieved an 11 percent increase in childhood immunization rates among members, since its inception in September 2000. The report highlights the program's use of incentives to parents for completing their children's immunizations on time and its provision of transportation to physician appointments when needed by members.

By identifying members at high risk for hospital readmission for congestive heart failure and then assigning innovative case management techniques to provide for and ensure proper care, Horizon/Mercy decreased member inpatient readmissions for congestive heart failure by 72 percent. The AAHP report outlines how Horizon/Mercy achieved this result in the program's first year.

"Our programs are improving the health of our members," said Dr. Miller. "Our goal is to continue to provide quality preventive programs and services that meet members' healthcare needs."

Horizon/Mercy is New Jersey's largest managed healthcare organization serving the publicly insured, providing healthcare services to more than 270,000 people in all 21 New Jersey counties. With headquarters located in Trenton, N.J., the organization is a partnership of Horizon Healthcare of NJ, Inc., a subsidiary of Horizon Blue Cross Blue Shield (HBCBS), and Mercy Health Plan, a subsidiary of Mercy Health System.