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Value-Based Programs Continue to Show Improvement

October 23, 2017

Applies to: All Markets

More than 1.5 million Horizon Blue Cross Blue Shield of New Jersey members currently participate in one of our patient-centered, value-based programs.

Horizon BCBSNJ reviewed claims data for members receiving care from patient-centered practices and compared those findings to members receiving care from traditional primary care practices for services in 2016. The results continue to demonstrate that patient-centered practices are delivering more cost-effective and efficient care, which is helping to ensure members receive care at the right time and appropriate care setting. The results show that members participating in patient-centered practices, as compared to those members in traditional practices, had a:

  • 3 percent lower total cost of care
  • 3 percent lower rate of Emergency Room (ER) visits
  • 4 percent improved control of diabetes costs
  • 3 percent lower rate of hospital inpatient admissions
  • 5 percent higher rate of colorectal cancer screenings
  • 3 percent improved rate of diabetes control
  • 3 percent higher rate of breast cancer screenings

Patient-centered practices helped Horizon BCBSNJ members avoid more than 2,000 ER visits and more than 600 inpatient stays in 2016.

In 2016, 67 percent of Horizon BCBSNJ’s medical spend was for members who received some or all of their care from a patient-centered doctor or hospital. These health care professionals are helping to improve the quality of care for Horizon BCBSNJ members, while controlling costs and improving the patient experience.

There are more than 4,500 Primary Care Physicians (PCPs) and thousands of specialists in Horizon BCBSNJ’s patient-centered programs. For 2016, participating patient-centered providers received a total of $94.9 million in value-based payments from Horizon BCBSNJ. Since 2013, Horizon BCBSNJ has made approximately $228 million in value-based payments to patient-centered providers.

Horizon BCBSNJ’s patient-centered programs deliver members coordinated and personalized care. Practices may include a care coordinator who provides additional patient support, information and outreach. Patient-centered practices also actively coordinate the work of specialists and other health care professionals and provide an increased focus on wellness and preventive care. This active monitoring, engagement and communication helps patients get and stay healthy and avoid more costly, complicated and serious health conditions.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

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Published on: October 31, 2017, 07:18 a.m. ET
Last updated on: April 26, 2021, 02:22 a.m. ET