Putting Our Members First

Horizon BCBSNJ is committed to improving health care for our members so they can live their best lives. Our members are at the core of everything we do, whether it is developing solutions that focus on improving health care quality, affordability and the customer experience, or building patient-centered models, tools and partnerships that achieve these goals.

Our commitment to our members led to Horizon BCBSNJ being named the exclusive medical carrier for the state of New Jersey’s public employee health programs, the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP). Following a competitive bidding process, Horizon BCBSNJ emerged as the state’s top choice to provide network, claims, navigation and advocacy services for the nearly 600,000 active and retired public employees under age 65 who are covered by the SHBP and SEHBP. Horizon BCBSNJ has held this honor since 1996, and it reinforces Horizon BCBSNJ’s position as the premier health insurer in New Jersey.

While retaining the state account was a priority in 2019, we were equally focused on providing all of our 3.5 million members with coverage and services to help them achieve their best health. This included launching several innovative collaborations.

 

Improving Outcomes through Analytics

In June, we announced a new partnership with Aetion, a health care technology company that uses near real-time data analytics to identify high-risk members and implement targeted formulary and drug-adherence interventions to improve outcomes. By using medical and pharmacy claims data to optimize treatment pathways across nine therapeutic areas, we are supporting pharmacy case management interventions and the development of value-based agreements with pharmaceutical companies for specific patient populations.

Our initial intervention program focused on type 2 diabetes. Future efforts will analyze therapeutic areas including inflammatory bowel disease, immunologic diseases, non-valvular Atrial Fibrillation (AFib), cancer, Chronic Obstructive Pulmonary Disease (COPD) and asthma.

 

Research Breakthroughs with Rutgers

Our relationship with New Jersey’s premier research institution, Rutgers University, created one of the state’s most powerful medical research partnerships. While Horizon BCBSNJ and Rutgers University have engaged in collaborative research for more than two decades, this new partnership expanded those efforts and has already led to more than 14 projects, including research that may yield breakthroughs to make cancer screenings more conclusive; improve the effectiveness of flu vaccines; adapt to the health consequences of climate change; and deploy virtual reality devices as a pain treatment alternative to opioids.

 

A First-of-Its-Kind Model of Care

In October, we announced our partnership with the New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) and RWJBarnabas Health to create an innovative, value-based Medicaid model to reduce health disparities in maternal health in New Jersey. With New Jersey ranking 45th in the nation in maternal mortality with 38.1 deaths per 100,000 births (according to the 2018 Health of Women and Children Report), this first-of-its-kind model is designed to make New Jersey a model state for improving maternal health, and close racial health disparities in maternal-child health among the state’s Medicaid population.

This effort is also expected to address social determinants of health and generate best practice and policy recommendations to be distributed to health care payers and providers nationwide.

 

Sharing Best Practices

Understanding the important role that nurses and social workers play in a patient’s health care experience, Horizon BCBSNJ created a Clinical Advisory Council of Nurses and Social Workers. The Council’s unique perspectives and relatable skills enable participants to learn from each other while collaborating on solutions that will make an impact on health care.

Like our three physician advisory panels, this Council includes experienced clinicians and leaders from a range of clinical and academic organizations from across the state, as well as from our Company.

 

Strength in Numbers

We also continued our efforts to collaborate with Primary Care Physicians across the state to identify undiagnosed and undertreated behavioral health issues among our members, and then connect these doctors and their patients, who may have mental health or Substance Use Disorders, to the appropriate treatment providers.

In addition, we worked closely with the Partnership for a Drug-Free New Jersey, the federal Drug Enforcement Agency, schools, colleges, grass roots organizations, the cultural community and many others to raise awareness among thousands of New Jersey residents to the causes and effects of the opioid epidemic. Much of this work was done through relationships with The Horizon Foundation for New Jersey.