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Patients of Value-based Care Providers Have Better Outcomes that Lower Total Cost --Value-based Payments to Physicians Up 10%

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that in 2017, members receiving care from doctors who participated in one of its patient-centered, value-based care programs were less likely to be admitted to the hospital, more likely to have essential health screenings, and had a lower overall cost of care. The company also reported that more than 70% of its in-network primary care doctors participated in one or more of Horizon BCBSNJ’s value-based care programs - a 20% increase over the last two years. Thousands of specialists also participate in those programs.

“Horizon began engaging doctors in value-based care collaborations nearly a decade ago and these results confirm that it is our members – their patients - who benefit most when we create a strong partnership and work as a team to provide the care they need. The question is no longer whether to pursue value-based partnerships, it is which models deliver the best quality improvements, best patient experience and are most effective at lowering an individual’s total cost of care,” said Allen Karp, Executive Vice President for Healthcare and Transformation Management, Horizon BCBSNJ. “We owe it to our members to continue driving changes and expanding the value-based partnerships that are making it easier for our members to get the right care, in the right setting at the right time.”

According to 2017 results, when compared to all commercial members, members engaged with value-based providers experienced a:

  • 4% lower total cost of care trend*
  • 4% lower rate of hospital inpatient admissions
  • 6% higher rate for colorectal cancer screenings
  • 7% higher rate of breast cancer screenings

Value-based care providers produced dramatic improvements in 2017 managing members with chronic conditions that require ongoing medical attention and intervention. For example, results show that members under the care of a value-based provider had:

  • 24% lower rate of readmissions for patients with diabetes
  • 11% improvement in diabetes management
  • 6% lower medical cost trend for patients with congestive heart failure
  • 2% reduction in potentially avoidable ER visits year over year.

Dr. Thomas R. Graf, Chief Medical Officer and Vice President for Healthcare Transformation, Horizon BCBSNJ, noted that the success of the value-based approach to care demonstrates the power of collaboration between two sides that are too often seen as having a competing, instead of a common, focus.

“The better outcomes and lower costs demonstrate that a health insurer like Horizon can have a very different kind of relationship with its network doctors and hospitals and that working together fulfills our common commitment to do what is best for our patients and members,” Graf said. “I want to thank the overwhelming majority of doctors, healthcare providers and hospital leaders who are working with us to recognize that value-based care is the best way to produce real improvements in health care quality, affordability and the patient experience.”

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. In 2017, these value-based payments totaled $104 million and were in addition to what those providers were reimbursed on a fee-for-service basis. Horizon has several value-based care initiatives including the OMNIA Health Alliance, Accountable Care Organizations, Patient-Centered Medical Homes, and Episodes of Care.

*Value based care providers bent the cost curve downward: members connected to those providers experienced a 4% lower increase in the total cost of care compared to commercial members as a whole.

About Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey, the state's oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.8 million members.

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Published on: September 26, 2018, 15:11 PM ET
Last updated on: September 26, 2018, 15:16 PM ET