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Value-Based Programs Continue to Show Improvement

Horizon BCBSNJ’s collaborations with patient-centered doctors continue to improve care and control health care costs

More than 1.5 million Horizon BCBSNJ 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% lower total cost of care
  • 3% lower rate of Emergency Room (ER) visits
  • 4% improved control of diabetes costs
  • 3% lower rate of hospital inpatient admissions
  • 5% higher rate of colorectal cancer screenings
  • 3% improved rate of diabetes control
  • 3% 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% of all Horizon BCBSNJ’s medical spend was for members who received some or all of their care from a patient-centered health care professional 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 health care professionals 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 health care professionals.

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.

Published on: October 24, 2017, 02:39 a.m. ET
Last updated on: October 24, 2017, 02:53 a.m. ET