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Good Care Makes You Feel Cared For



This is third in a series of essays by Horizon’s executive leaders describing their approach to improving health care quality, affordability and customer experience to achieve what’s known as “The Triple Aim of Health Care.”

By Mark Barnard, Executive Vice President, Government Programs & Operations

What should high-quality health care feel like to a patient, and how does the way that health care is delivered impact a person’s overall health?

We spend a lot of time talking about what constitutes “high-quality health care” – the kind and amount of care to provide, in what setting and at what cost. Those are certainly important factors in improving the health of the people we serve. But it’s equally important to think about what patients experience when they engage with the health care system.

What shapes people’s sense of quality.

The experiences we have with health care strongly shape our sense of quality and our willingness to get care when we’re not well. If getting the care you need feels overwhelming or unsettling, you’re more likely to avoid the routine care that keeps you healthy or the treatments that get you better.

Similarly, you can receive the best clinical care in the world, but if that care is delivered in a way that doesn’t make you feel cared for – e.g., it’s difficult to coordinate your care team or you don’t understand what’s happening and why – you’re not likely to feel that you’ve received high-quality care.

The health care system is more advanced – and more complicated – than ever. On top of that, consumers have come to expect an experience that puts a premium on convenience, ease and simplicity.

How our members experience healthcare is very much on our minds at Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). After all, our mission statement begins with a commitment to “Empower our members to achieve their best health,” and number one on our list of core values is “We care for our members.” That’s why improving patient experience stands shoulder-to-shoulder with quality and affordability to form our Triple Aim of Health Care. It’s a framework designed to improve the performance of the U.S. health care system, and it guides everything we do at Horizon BCBSNJ.

Doing our part to create a seamless health care experience.

We recognize that caring for our members today means more than simply providing an unmatched network of doctors and hospitals, accurate claims processing and financial security. Our members want us to work more closely with health care providers to create an orderly, predictable and seamless health care experience with all of the details attended to in the background. They expect more convenience and coordination and fewer unknowns and surprises.

To help improve their experience, we’re giving members user-friendly tools to navigate the healthcare system more effectively. Our new Horizon Blue App helps them find an in-network healthcare provider, schedule an appointment, check on a claim, chat with a nurse or doctor or consult with a service representative – right from the palm of their hands. Soon, they’ll be able to rely on the app to pull together everything they need to achieve their best health – medical records, wellness programs, pharmacy services and more -- to deliver a one-stop, seamless customer experience.

Helping doctors help patients.

By arming doctors with leading-edge data tools and analytics, we’re unlocking the power inside our claims database to improve the care they deliver to our members. Using HealthSphere, our new medical records sharing platform, care delivery teams can get a 360-degree view of a member’s medical records, including office visits, diagnoses, prescriptions and lab work. Doctors can then access these records through a secure website, eliminating redundant tests and paperwork and creating a better overall experience of care for our members.

Technology improvements are fueling many other enhancements to our members’ healthcare experience – from personal videos that help members learn about their coverage to educational videos on topics like pharmacy benefits that generate lots of questions.

But technology can only go so far in shaping a positive healthcare experience. In addition to those “high tech” investments, we’re also developing “high-touch” solutions that wrap our members in the kind of personal attention they’ve come to expect from a trusted advisor.

We’re assigning nurses to serve as complex case managers to work with members facing more serious conditions like sickle cell anemia, stroke or cancer, answering questions and arranging all the care they need to get better.

Launching an award-winning pilot program.

Recently, we launched a pilot program to streamline our customer service experience. We’ve given our service representatives more resources and training and a simple directive: solve a member’s problem no matter how long it takes and without transferring them between departments or agents.

This extra dose of personal care had a significant impact on member satisfaction, which jumped more than 20 percentage points to 90 percent. Problem resolution improved, while the number of repeat calls declined. The pilot program also gained national recognition when one of our customer service reps was named Customer Representative of the Year by a market research firm that specializes in improving the customer experience. We’re now planning how best to expand that program.

Whether high-tech or high-touch, the goal of all these programs is to humanize healthcare. It’s easy in the healthcare world to think about patients in abstract or collective terms – as representatives of a particular disease class, for example, or demographic group. Focusing on our members’ experience requires a fundamental shift in perspective. It calls us to see our members as human beings in all their individuality.

At Horizon BCBSNJ, we recognize the importance of maintaining this perspective. We not only want our members to know about our commitment to helping them “achieve their best health.” We want them to feel it, too.