Horizon Selected as Administrator of State and School Employees’ Health Benefits Programs

On Sep 30, 2019

The state of New Jersey has selected Horizon BCBSNJ as its exclusive medical carrier to provide network, claims, navigation and advocacy services for the active and retired public employees under 65 who are covered by the state’s two health programs: the State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP). Horizon BCBSNJ expects to produce additional annual savings of $200 million to the state.

“Horizon is truly honored to continue to earn the trust of the state and the leadership of the public employee unions who chose us to help protect the health of the people who teach our children, watch over our families, and make New Jersey work,” said Christopher M. Lepre, executive vice president commercial business at Horizon BCBSNJ. “Those leaders deserve credit for raising the bar and demanding solutions that focus on improving health care quality, affordability, engagement, and customer experience.”

The new contract reflects many of the recommendations made by the State Health Benefits Quality and Value Task Force including new performance and accountability benchmarks, an increased focus on the use of analytics and data to improve outcomes and reduce costs, and a priority on quality.

The new contract also includes an administration initiated requirement for advocacy and navigation services that will make New Jersey the largest public employer to date to engage navigation services on this scale. Beginning in January 2020, Horizon Health Guide will provide SHBP and SEHBP members with dedicated, one-stop customer service, case management, and clinical resources. The innovative platform includes both technology and live engagement and uses health information, analytics, and predictive modeling to identify and guide members to health services and resources addressing their specific health needs.

The $200 million in savings will be achieved in variety of ways including: new, SHBP/SEHBP specific rates negotiated with nine health systems; increased reliance on Horizon’s patient-centered, value-based care models; enhanced code review to improve claims payment accuracy; the Horizon Neighbors in Health program that addresses Social Determinants of Health specific to the community where a member lives, including housing, affordable healthy food and access to reliable transportation; and, a Supportive Care Program using predictive modeling to identify members with progressive functional diseases, physical decline or a terminal illness and connects those members with a Supportive Care case manager trained in palliative and hospice care.

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