Could Shared Accountability Make Denials Obsolete? Horizon BCBSNJ Leader Says, 'Absolutely'
"This is not a classic relationship between a provider and a payer. In fact, what we're doing is blurring the lines to try to come up with a better model to take care of our members and the patients of Atlantic," says Allen Karp, executive vice president of health care management and transformation for Horizon Blue Cross Blue Shield of New Jersey.
Denials are the bane of revenue cycle leaders' existence, which are often underscored with tense and often adversarial relationships between providers and payers.
But payer-provider shared accountability programs, where payments are tied to outcomes in achieving quality and cost goals, rather than volume, have the potential to dramatically change the way payers and providers work together.
That's the goal for Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) and Atlantic Health System, which are seeing early success with a model in which the two New Jersey organizations share the financial accountability for the health, quality of outcomes, and total cost of care for a specified population of patients.