Horizon Blue Cross Blue Shield of New Jersey members are experiencing a higher and more rigorous level of care because their physicians, hospitals and other health care professionals participate in one of the company’s patient-centered, value-based programs.
The 2018 results also indicate that clinical quality in pediatric care is excelling, with significant improvements in immunization rates for both young children and adolescents whose doctors participate in Horizon BCBSNJ’s value-based program for pediatrics.
More than 1.7 million Horizon BCBSNJ members, including Medicaid/FamilyCare members, participated in patient-centered programs last year. Allen Karp, Horizon BCBSNJ’s executive vice president for Healthcare Management and Transformation, said the 2018 results are a testament to how members benefit when Horizon BCBSNJ and like-minded doctors and hospitals work together to align provider payments with mutually agreed-upon goals for achieving and measuring improvements to patient health.
“Horizon and our provider partners are able to achieve better outcomes together because we freely exchange knowledge and expertise, and we share claims data and resources that help doctors better understand their patients and our members. We also all believe that by working together as a team, versus separately in silos, we have the best chance at delivering better care, a better patient experience and lowering costs for the patients we serve,” Karp said.
Horizon BCBSNJ provides care coordination and shared savings payments to doctors and organizations led by health systems that participate in one or more of its value-based programs.
According to Horizon BCBSNJ, in 2018, these value-based payments totaled $100.8 million. Approximately 61 percent of the total amount Horizon BCBSNJ spends on medical care goes to value-based doctors and hospitals.
When comparing results of Horizon BCBSNJ members engaged with a patient-centered practice to results of members with non-value-based practices, value-based attributed members in 2018 experienced a 6 percent higher rate of breast cancer screenings and a 4 percent higher screening rate for cervical cancer.
The 2018 results, according to Horizon BCBSNJ, also revealed substantial progress from 2017 to 2018 in the quality of care for more than 100,000 children who are attributed to one of 74 practices participating in Horizon BCBSNJ’s Pediatric value-based program.
For example, year-over-year comparisons for these patients show an 11 percent increase in adolescent immunizations, a 9 percent increase in weight counseling and monitoring visits and a 21 percent increase in child well visits.
Dr. Don Liss, vice president and chief medical officer for Horizon BCBSNJ, said that in addition to year-over-year quality improvements among pediatric members, patient-centered pediatric practices are also outperforming national standards of quality, as measured by Healthcare Effectiveness Data and Information Set (HEDIS) scores. The 2018 results show that 7 percent more 2-year-olds received vaccinations compared to the National 50th Percentile of HEDIS, while 14 percent more adolescents were immunized.
“The well-defined clinical information we receive through our partnership with Horizon allows us to regularly review our performance and understand how we can achieve and outperform the quality outcome objectives we set for our patients,” said Dr. Jill Stoller, president and CEO of BCD Health Partners LLC, which participates in Horizon BCBSNJ’s Pediatric value-based program. “We see even greater potential for improving patient care quality as Electronic Medical Records capabilities improve and the data we share with Horizon becomes even more defined and precise.”
More than 4,500 primary care physicians and thousands of other doctors, specialists and health care professionals participate in Horizon BCBSNJ’s value-based programs. Horizon has several value-based care initiatives including the OMNIA Health Alliance, Accountable Care Organizations, Patient-Centered Medical Homes, and Episodes of Care.