Commercial Programs: RWJBarnabas Health Partners

RWJBarnabas Health Partners has relationships with many commercial payers and seeks to improve the quality of care provided to beneficiaries while managing the costs of caring for patients. Many of these commercial value-based models offer some up-front financial support for transforming to a value-based practice as well as an opportunity to participate in shared savings.

Commercial payers

Integration

Doctors who are solo practitioners or part of a small practice face a difficult environment, where the low levels of reimbursement can’t support the growing overhead burdens of running a practice. Some practices have agreed to be purchased, some doctors have elected to be employed by hospitals or urgent care centers, while others are interested in joining or forming a larger entity, but are often too busy to pursue the opportunity. Strong independent group practices that are aligned with an engaged health system in a clinically integrated model are often the best solution.

Financial Model

The benefits of integration are access to the following financial model:

  • Care Management Fees
  • Shared Savings Opportunity

Population Health Management & Clinical Outreach Programs

RWJBarnabas Health Partners deploys an interdisciplinary team to support the practices and patients by ensuring compliance with physician-patient plans of treatment. Our model has demonstrated that increased outreach leads to greater compliance, higher clinical-quality measures and lower costs. Our support services include:

  • Care Management & Care Coordination
  • Behavioral Health and Clinical Pharmacist Support
  • Access to a Medical Neighborhood composed of high quality providers that eliminates access barriers, assists in pre-certifications/pre-authorizations, and reduces the burden of connecting and ensuring patient follow-up

Medical Neighborhoods

A collaboration between primary care and specialty physicians committed to providing improved access and high quality care for patients. RWJBarnabas Health Partners has Medical Neighborhoods deployed in the following regions:

  • Essex County
  • Hudson
  • Union/Middlesex
  • Somerset
  • Ocean/Monmouth
  • Mercer

Practice Support/Transformation

  • Assistance with improving work flows
  • MACRA and MIPS benefits
  • Electronic Health Record optimization
  • Access to best practices
  • Physician recruitment

Traditional MSO Services

  • Electronic Health/Medical Record
  • Supply Chain/Medical Supplies
  • Revenue Cycle Management

 

Commercial Programs