Improving Our Members’ Experience

We know that many of our members spend their time juggling competing priorities, such as finding suitable childcare services, locating and eating healthy foods, accessing adequate public transportation and finding a doctor with flexible hours. To help members overcome these barriers, Horizon Neighbors in Health was developed as a partnership between Horizon BCBSNJ and several health systems across the state.

The program offers eligible members:

  • Assistance with coordinating care and scheduling medical appointments
  • Assistance with accessing transportation, healthy foods and housing
  • Help with setting and achieving health goals
  • Referrals to community resources, life coaching and skill building
  • Help in understanding how their Horizon BCBSNJ benefits work

 

In addition, through the Horizon Neighbors in Health: Education Works program, we are giving eligible Horizon NJ Health members, ages 18 years and older, an opportunity to earn their high school equivalency diploma at no cost to them. Members are given a custom plan with the tools, resources and information they need, including telephonic coaching to help them stay on track and one-on-one meetings with a coach who helps them remove barriers that may prevent them from getting their high school equivalency diploma.

Social Determinants of Health

TRANSCRIPT

Tarloh Mouphouet, Personal Health Assistant, Horizon BCBSNJ: “My name is Tarloh Mouphouet, and I am a Personal Health Assistant. The program seeks to improve overall patient experience and lower costs.”

Chantel Wade: “My daughter is 11 years old. She’s my only child. I was so overwhelmed with what we were going through at the time. You know it’s difficult to get your own self together but then when you’re trying to take care of somebody else if you’re not right, you can’t take care of them.”

Chantel Wade: “Tarloh, she did help me find a doctor and set up the appointment for me. Getting a response was so gratifying to me because it was like, “Wow, okay, she cares just as much as I do.”

Dereavia Wooten-Scott: “My name is Dereavia Wooten-Scott. I had a lot of health issues. I had a thyroid problem that I had surgery, and the thyroids had been removed. Coming home was very painful. I couldn’t eat.”

Clare Mooney, RN, CCM, CCCTM, Care Transformation Specialist, Horizon BCBSNJ: “Chantel and Dereavia are good examples of members who had chronic illnesses, going to the doctor, but there were things that were obviously falling through the cracks because they were getting sicker. The outcomes were not good.”

“We’ve actually developed a relationship with these members where we’re like their good neighbor, or a family member.”

Dereavia Wooten-Scott: “Everybody was so concerned about my health. They all had compassion and they was meeting the goals that I needed. I feel that it helped me heal faster.”

Chantel Wade: “It was something that I didn’t think that insurance companies actually provided or did. It almost sounded too good to be true.”

Clare Mooney, RN, CCM, CCCTM, Care Transformation Specialist, Horizon BCBSNJ: “We’ve seen very impressive decreases in total cost of care, and a lot of very happy members.”

Dereavia Wooten-Scott: “All I can say is that I’ve been blessed to have Horizon in my life.”

Empowering Members to Make Their Own Choices

Through our Supportive Care Program℠, we helped members who were experiencing a serious medical illness or undergoing treatment. This free and voluntary pilot program connected these members to palliative care services that improve the quality of life for both them and their families. Supportive care nurses worked with members, their families and their doctors to help them identify personal care goals, navigate the health care system, understand their benefits and collaborate to address their specific needs. While this pilot program is no longer active, many of the lessons learned have been incorporated into our care management programs that help our members deal with their medical conditions every day.

Supportive Care Program: Helping Members at a Time of Need

TRANSCRIPT

Dorothy Mullen: “My name is Dorothy Mullen. My journey into palliative care started when it was revealed that I had stage 4 lung cancer. So, I had absolutely no idea until I was at stage 4. It was a telephone call from Helen DeLuca from Horizon Blue Cross Blue Shield [of New Jersey] informing me that this visit by a doctor who does palliative and hospice care was available.”

Helen DeLuca, R.N., Supportive Care Nurse, Horizon BCBSNJ: “I researched her case. I was excited to discuss with her the opportunity for a palliative care referral with Samaritan. So, she agreed, the doctor’s office agreed.”

The Supportive Care Program℠ is based upon giving patients end-of-life with dignity, with control of their destiny, as far as what they want done, as much as they want done, as little as they want done. We collaborate with family members; we collaborate with the doctors. We make sure that the patient’s needs are met.”

Stephen Goldfine, Chief Medical Officer, Palliative Medical Partners, Samaritan Healthcare & Hospice: “Dorothy is an amazing, wonderful person. In her mind, she really was not going to get aggressive treatment but did not know how to go about having her symptoms managed, as well as her quality of life taken care of. Our conversations really circled around, what is important to you, what is your quality of life, what is your goal of care? How can we at Samaritan, as well as Horizon, obtain that goal of care for you and that quality of life for you?”

Helen DeLuca, R.N., Supportive Care Nurse, Horizon BCBSNJ: “She made it pretty clear that she didn’t want to take any opioids or medications that would cloud her judgment. She was looking for comfort measures that were outside of medicine.”

Dorothy Mullen: “Supportive care means that I can have whatever services that I need on my own terms. I’m an organic gardener and it’s very much in keeping with who I am.”

Helen DeLuca, R.N., Supportive Care Nurse, Horizon BCBSNJ: “The Supportive Care Program enriches patients because we deal with the whole patient, we just don’t deal with the medical condition. We deal with their social, spiritual, family connections. We’re good listeners. If you want something, I will do whatever I can within my ability to make sure that it happens.”

Managing Care for the Body and Mind

It is no secret that how we feel affects how we heal. Mind and body health are dependent upon each other. We recognize the importance of treating the health of our members as a whole, and we seek to address our members’ unique needs with more integrated care.

This past year, we began transitioning the administrative and clinical management of the Horizon Behavioral Health℠ program — behavioral health services and benefits — from Beacon Health Options (formerly ValueOptions) to our internal team of professionals. By managing these services and benefits internally, we are in a stronger position to work directly with providers and health systems to improve the integration of physical and behavioral health care for our members.

Our Government Programs business (Medicare Advantage, Medicaid and Fully Integrated Dual Eligible Special Needs Plan) transitioned on December 29, 2019. Our Commercial lines of business transitioned on March 29, 2020.

 

Improving our Digital Tools

Horizon BCBSNJ remains focused on creating and delivering an improved, member-centric digital experience. In 2019, we were pleased to receive national validation that we’re on the right track with one of our most significant member-facing tools — the Horizon Blue app — receiving a FutureEdge 50 award, which recognizes organizations that use new technologies to push boundaries within their industry.

We continue to improve and expand the app’s capabilities, with links to wearables, such as smartwatches, and connections to a patient’s electronic health records.

By using the Horizon Blue app, members can now:

  • Chat live with nurses 24/7 to get medical advice
  • Chat with a Horizon BCBSNJ service representative to address benefit or claim questions
  • Pay their premiums and set up auto pay (Individual and Medicare members)
  • View their benefits and claims and find in-network doctors and hospitals nearby using Apple or Google maps
  • Access a digital copy of their Horizon BCBSNJ member ID cards and digital Explanation of Benefits (EOBs)
  • Access their Health Savings Accounts, Health Reimbursement Accounts and Flexible Spending Accounts

More than 171,000 members downloaded the Horizon Blue app in 2019, bringing the total amount of Horizon BCBSNJ members now using the app to more than 200,000 since its launch.

To download the app, members can simply text GetApp to 422-272, or search for Horizon Blue in the Apple or Google app stores.

 

Improved Access to Information

In 2019, we made it easier for our members to find their health plan information, determinations and communications through the Horizon Blue app and the secure member web portal, HorizonBlue.com. Members who are registered with our secure member web portal, and who agree to receive electronic communications, now receive their EOB statements electronically. They can access and print EOB statements from the app and web portal weeks before they would have received them in the mail, and can easily find and view an EOB for up to 18 months after it was issued.

 

Increased Access to Care

Getting blood and other lab work done got easier for many of our members in 2019. LabCorp remains in network for all Horizon BCBSNJ plans, and in 2019, depending on the member’s health plan, members can now visit Quest Diagnostics lab locations at the in-network level of benefits. BioReference continued as an in-network lab for certain plans, and our networks include a number of participating laboratories that provide a variety of specialized laboratory services.

Expanding our laboratory network is part of our continued commitment to giving our members access to quality care while lowering their out-of-pocket costs.