Change agents

As part of its value-based transformation initiative and ongoing work to proactively collaborate with providers and members, Horizon Blue Cross Blue Shield of New Jersey (HBCBSNJ) developed the Clinical Advisory Council of Nurses.

Similar to its three physician advisory panels, Horizon’s nurse’s council includes experienced nurses from a wide range of clinical and academic organizations, as well as Horizon’s own nurses.

“We know that nurses really are in the front line in the doctor’s offices and the health care system and even internally in many of the functions that [Horizon’s] nursing staff are involved in. We wanted to create this forum to give a voice to their insights and experience,” said Susan Porretta, director of partner transformation at HBCBSNJ.

It’s an opportunity for nurses from different aspects of the field to come together to give Horizon some feedback on innovative ideas that are taking off.

– Nicole Camporeale

Porretta is a registered nurse who helps practices as they move into value-based care. She works with provider partners in primary care offices and ACOs, and meets with the nurse and physician leaders responsible for transitions of care and care management activities that they have in place in their practices.

“We look at how we can support practices without duplicating efforts to get the quality outcomes that we’re all striving for,” said Porretta.

Porretta said one of the things that she is hearing from her colleagues on the council is that there are not enough resources to fill gaps of care in several pockets of New Jersey’s health care landscape. At the same time, she said there is a need to better coordinate care management services among Horizon and health care providers.

“That’s where this council, working collaboratively, can do that. There are nurses that work for the health plans, in the doctor’s office, in health system and ACOs. We want to maximize those touch points and avoid duplication so that there is clear, consistent messaging to patients, to members.”

Filling the gaps

For example, Porretta said if someone is a diabetic and needs education, quality measures are put in place to ensure that patients get the care they need, such as screenings.

“As an insurance company we also provide reports that determine where the care gaps are so our provider partners can outreach to the patient and close those gaps in care.”

Nicole Camporeale, administrative director of clinical operations & compliance for Hunterdon Healthcare Partners, said the council is comprised of highly experienced, knowledgeable nurses who bring real-world perspective and experience to the table.

“Professionally for me it is a win-win because it allows us the opportunity to network and learn from each other.”

Camporeale said that the purpose of the council is to gain a broader perspective on important issues occurring in health care and to have the opportunity to contribute to improving Horizon’s value-based care programs to make them more meaningful and actionable for patients.

“It’s an opportunity for nurses from different aspects of the field to come together to give Horizon some feedback on innovative ideas that are taking off. To give input on those ideas to see if they make sense, to see if they might tweak them to be more patient-centric, and give them a heads-up on potential roadblocks they may encounter with those interventions,” Camporeale said.

She added that Horizon is seeking to integrate pharmacists, behavioral health providers, nutrionists and social workers in an effort to determine how to bring more professionals into the care team and expand services to patients.

“That’s important because health care has become more and more complex. Benefit structure and design has changed so sometimes by the time patients hit our doors they are really sick, requiring a higher level of care and team-based services.”

And, she said, “[o]ne of the things Horizon wants to figure out from this team is how to integrate various care team members from their side, into the provider side so that we’re working together and collaborating instead of working in silos.”

She said the program is about putting together a group of knowledgeable, innovative nurses who are working in the field and have a deep understanding of some key health care issues that plague the industry.

“It is a multipronged approach whereby Horizon wants to figure out what we are already doing in the practices, then determine how they can align with our processes and not duplicate and waste resources doing the same thing,” said Camporeale.

“I think it’s a win all around for council members, Horizon and our patients because we get the opportunity to network and learn from each other to gain a broader perspective, then share back best-practices with our organizations to improve health outcomes.”