Horizon Blue Cross Blue Shield of New Jersey Collaborates with Patient-Centered Doctors

On Sep 6, 2016

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:

• 12 percent lower cost of care for members with diabetes.
• 2 percent higher rate in breast cancer screenings.
• 5 percent lower rate of emergency room visits
• 2 percent lower rate of hospital admissions

“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:

• A care coordinator who provides additional patient support, information and outreach.
• Wellness and preventive care based on national clinical guidelines.
• Extra wellness support and education.
• Active patient monitoring and communication from the doctor and care coordinator.
• Active coordination of a patient’s care with specialists and other providers.

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.

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