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N.J. primary-care pilot program aims to let doctors spend more time with patients

Riverside Township resident Ronald Russell has been paying $130 a month -- on top of the health insurance he has as a retired police officer -- to cover primary care for his family of five.

It's worth it, he said of the care his family receives from Steven Horvitz in Moorestown.

"It's almost like a concierge. You pay a monthly fee for a family, and you have access to the doctor 24/7. There are no co-pays when you go to see him. He gives you his cellphone, his email address. The office is always available," Russell said.

Now, under a pilot program for people covered by public-sector health plans in New Jersey, Russell no longer has to pay the monthly fee.

Horvitz, the Russells' family doctor, has signed up with R-Health, an Elkins Park company that has a contract to provide what is called direct primary care to beneficiaries of the New Jersey State Health Benefits Program and School Employees' Health Benefits Program.

Under the three-year pilot, which started last month when R-Health's contract took effect, as many as 60,000 teachers, police, firefighters, and other state and local government employees will be allowed into the program. It's a free add-on to their current plans and is designed to give doctors more time to spend with patients, with the goal of reducing long-term spending on health care.

In addition to Horvitz, R-Health currently has doctors signed up for the program in Haddonfield and Washington Crossing. A fourth doctor, near Trenton, is scheduled to start early next year.

"We get paid a fixed amount to deliver an expanded range of primary care," said Mason Reiner, R-Health's chief executive.

Another company is expected to have a contract to deliver the care in North Jersey.

When the program was introduced last year, New Jersey Senate President Steve Sweeney described it as a "great program for both taxpayers and employees because it will cut health-insurance costs for governments and school districts, and reduce employee contributions."

The big difference between direct primary care and other popular programs designed to enhance the patient-doctor relationship is that the physicians in the New Jersey program have to give up all fee-for-service payments, which tend to force doctors to gear their practice toward large volumes of patients.

Under the direct primary care pilot in New Jersey, doctors will receive an undisclosed per-member fee per month, plus potential incentives based on clinical outcomes and patient satisfaction. "It's true value-based care, with no volume-based incentive," said Reiner. Those fees are typically $50 to $80 a member a month, he said.

Doctors in the New Jersey program will be limited to 1,000 patients. In the fee-for-service world, doctors typically have between 2,000 and 2,500 patients, according to the American Academy of Family Physicians.

Long-term cost savings are expected because doctors will have more time to focus on preventive care and individual health plans for patients, which are particularly important for chronically ill patients, whose care is the most expensive.

Horvitz, the Moorestown family physician who is also R-Health's medical director for direct primary care in New Jersey, said he ended his insurance contracts in 2008 and switched to direct primary care with monthly or annual fees from his patients, though he continued to accept Medicare until 2012.

"When I went rogue and didn't take any insurance, one of the beauties was that 99.9 percent of my time was spent on patient care, not on number crunching and bureaucratic stuff," said Horvitz, who has 500 patients and expects to grow through R-Health.

Russell, 58, vouched for the attention that Horvitz gives patients.

"When your appointment time comes up, it's your appointment time, and he spends the time with you," Russell said. "He's not constantly looking over a computer screen. He sits and talks to you and listens to you."