PCMH results

Horizon BCBSNJ collaborates with patient-centered doctors to improve care and contain health care costs – boosting “value-based” reimbursements

More than 1 million Horizon Blue Cross Blue Shield of New Jersey members are now benefiting from patient-centered programs that incentivize doctors and hospitals to achieve better care coordination and improved care quality while reducing costs. In 2015, patient-centered practices and hospitals received $58.9 million in care coordination and shared savings payments for reaching quality and savings goals. These value-based payments were in addition to what the providers were paid through traditional fee-for-service reimbursements.

“Patient-centered care is delivering real results for our members in terms of improved quality outcomes and it is lowering the overall cost of care,” said Allen Karp, Senior Vice President, Healthcare Management for Horizon BCBSNJ. “Horizon is committed to patient-centered care and transforming health care delivery in New Jersey to a fee-for-value model. The level of financial support to our patient-centered, value-based providers speaks volumes about our commitment to a better, more cost-efficient delivery system in New Jersey.”

For 2015, Horizon BCBSNJ reviewed claims data for members receiving care from a patient-centered provider and compared those findings to members receiving care from traditional providers. The results show that patient-centered members had a:

• 12 percent lower cost of care for members with diabetes
• 2 percent higher rate in breast cancer screenings
• 5 percent lower rate of Emergency Room (ER) visits
• 2 percent lower rate of hospital admissions

“Patient-centered practices are not only helping Horizon members better manage and prevent diseases, they’re helping to bend the health care cost curve by reducing unnecessary ER visits, inpatient admissions, duplicative testing and other inefficiencies that don’t contribute to better care quality,”Karp said.

Patient-centered practices helped patients avoid more than 3,500 ER visits in 2015, resulting in a projected savings of over $2.6 million.

Practices are also credited with helping members avoid more than 400 inpatient stays – which would otherwise cost more than $4 million.

There are more than 4,100 primary care network doctors and thousands of specialist doctors in Horizon BCBSNJ’s patient-centered programs. These providers in 2015 received a total of $28.9 million in care coordination fees and $30 million in shared savings for a total of $58.9 million in value-based payments from Horizon BCBSNJ. Since 2013, Horizon BCBSNJ has made $125 million in value-based payments to its patient-centered providers.

The purpose of Horizon BCBSNJ’s patient-centered practices is to provide patients with more coordinated and personalized care, including:

• A care coordinator who provides additional patient support, information and outreach
• Wellness and preventive care based on national clinical guidelines
• Extra wellness support and education
• Active patient monitoring and communication from the doctor and care coordinator
• Active coordination of a patient’s care with specialists and other providers

Approximately 60 percent of all Horizon BCBSNJ medical claims spending in New Jersey during 2015 went to patient-centered network doctors and hospitals that are improving the quality of care for Horizon BCBSNJ members, while controlling costs and improving the patient experience.