Newark-based Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced today that more than one million members are now benefiting from patient-centered programs that incentivize doctors and hospitals to achieve better care coordination and improved care quality while reducing costs. In 2015, patient-centered practices and hospitals received $58.9 million in care coordination and shared savings payments for reaching quality and savings goals. These value-based payments were in addition to what the providers were paid through traditional fee-for-service reimbursements.
“Patient-centered care is delivering real results for our members in terms of improved quality outcomes and it is lowering the overall cost of care. Horizon is committed to patient-centered care and transforming health care delivery in New Jersey to a fee-for-value model,” said Allen Karp, senior vice president, Healthcare Management for Horizon BCBSNJ. “The level of financial support to our patient-centered, value-based providers speaks volumes about our commitment to a better, more cost-efficient delivery system in New Jersey.”
For 2015, Horizon BCBSNJ reviewed claims data for members receiving care from a patient-centered provider and compared those findings to members receiving care from traditional providers.
The results show that patient-centered members, as compared to those members in traditional practices, had a:
“Patient-centered practices are not only helping Horizon members better manage and prevent diseases, they’re helping to bend the health care cost curve by reducing unnecessary ER visits, in-patient admissions, duplicative testing and other inefficiencies that don’t contribute to better care quality,” Karp said.
Patient-centered practices helped patients avoid more than 3,500 ER visits in 2015, resulting in a projected savings of over $2.6 million.
Practices are also credited with helping members avoid more than 400 inpatient stays – which would otherwise cost more than $4 million.
There are more than 4,100 primary care network doctors and thousands of specialist doctors in Horizon BCBSNJ’s patient-centered programs. These providers in 2015 received a total of $28.9 million in care coordination fees and $30 million in shared savings for a total of $58.9 million in value-based payments from Horizon BCBSNJ. Since 2013, Horizon BCBSNJ has made $125 million in value-based payments to its patient-centered providers.
The purpose of Horizon BCBSNJ’s patient centered practices is to provide patients with more coordinated and personalized care, including:
Approximately 60 percent of all Horizon BCBSNJ medical claims spending in New Jersey during 2015 went to patient-centered network doctors and hospitals that are improving the quality of care for Horizon BCBSNJ members, while controlling costs and improving the patient experience.Related Articles: