Healthcare Management and Transformation
HCM&T is the primary force driving Horizon BCBSNJ’s strategy to transform health care in New Jersey by providing access to high-quality, affordable health care in the appropriate setting, at the appropriate time and at the lowest possible cost.
Healthcare Management and Transformation (HCM&T) is a shared services division that maintains the clinical operations, network management, care and quality management, behavioral health solutions, pharmacy benefit management, community health and clinical transformation operations for Horizon BCBSNJ’s Commercial and Government Programs lines of business. This includes provider (hospital, physician, pharmacy and ancillary) contracting and partnering with providers to establish innovative clinical programs and solutions that help our members make the best decisions about managing their health.
HCM&T is the primary force driving Horizon BCBSNJ’s strategy to transform health care in New Jersey by providing access to high-quality, affordable health care in the appropriate setting, at the appropriate time and at the lowest possible cost. Together, these three factors – appropriate setting, time and cost – enhance the health care experience of our members. Our clinical teams help our members access care and resources to get and stay healthy and provide support when our members need it most. The division also supports the Enterprise’s efforts to ensure compliance with regulatory requirements through targeted oversight and auditing of Horizon BCBSNJ-delegated activities and data management.
HCM&T is organized into the following major areas:
- Behavioral Health Solutions
- Clinical Operations
- Medical Economics
- Network Data Management and Data Cost Strategies
- Network Operations
- Clinical Re-engineering
- Community Health
- Flexible Structure Partners
- Healthcare Marketplace Innovation
- Health System Partners
- Medical Policy
- Population Health and Transformation
- Quality Management
- Specialty Care Value-Based Models