Changing Health Care, Changing Lives

One of the most important ways Horizon BCBSNJ empowers our members to achieve their best health is by collaborating with doctors, hospitals and other health care professionals across the state to help them deliver value-based, patient-centered care. Together we are committed to improving patient results.

We now have more than 1.6 million members and more than 4,500 in-network PCPs participating in one of our value-based programs. Thousands of specialists also participate in these programs.

“Our practice has been working collaboratively with Horizon BCBSNJ since 2010 and it’s been an exciting, fulfilling and admittedly challenging journey. We’ve learned together and continue to pursue a common vision of patient centeredness and value-based care. We’ve learned to use data and Population Health strategies to guide our efforts and recognize that trust and alignment between Horizon and our practice is necessary for success. At the same time we see this as an opportunity for primary care to grow to its potential in meeting our patients’ needs and to create a new model of care that not only promotes the doctor-patient relationship, but is professionally satisfying to our providers.”

Dr. Thomas McCarrick
Chief Medical Officer and Chief Analytics Officer, Vanguard Medical Group

Members receiving care from doctors and other health care professionals who participate in one of our patient-centered, value-based care programs are less likely to be admitted to the hospital, and more likely to have essential health screenings and a lower overall cost of care. This is especially true for members who have chronic conditions that require ongoing medical attention and intervention.

Our Episode of Care programs also focus on improving the specialized care of members for services beyond primary care.

2017/2018 Results for Patients in an Episode of Care (EOC) program vs. Non-EOC Patients:

  • 22 percent fewer hospital readmissions for hip replacement
  • 17 percent fewer hospital readmissions for colonoscopy procedures
  • 33 percent fewer Emergency Room visits for pregnancy
  • Non-EOC patients are twice as likely to have readmissions after knee replacement

The positive results from our existing EOC programs prompted a significant expansion to other complex conditions. We launched an EOC program for Substance Use Disorder (SUD) with a Certified Community Behavioral Health Clinic, as well as EOC programs for Inflammatory Bowel Disease (IBD) with other concurrent disease states such as depression and anxiety issues, Lumbar Spinal Fusion and Cardiovascular Disease, and an Oncology Medical Home.

In total, nearly 40,000 members are benefitting from our EOC programs, supported by more than 85 specialty practices comprised of more than 1,200 physicians throughout New Jersey. The annual gross savings achieved by the EOC programs is nearly $44 million.