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Horizon BCBSNJ and its patient-centered doctors and hospitals make strides in improving care, child wellness in 2018


Annual patient-centered results show practices earned more than $100 million in added payments by improving care quality for adults, children

(Newark, NJ, December 3, 2019) – Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) members are experiencing a higher and more rigorous level of care because their physicians, hospitals and other health care professionals participate in one of the company’s patient-centered, value-based programs. The 2018 results also indicate that clinical quality in pediatric care is excelling, with significant improvements in immunization rates for both young children and adolescents whose doctors participate in Horizon BCBSNJ’s value-based program for pediatrics. More than 1.7 million Horizon BCBSNJ members, including Medicaid/FamilyCare members, participated in patient-centered programs last year.

Allen Karp, Horizon BCBSNJ’s Executive Vice President for Healthcare Management and Transformation,, said that the 2018 results are testament to how members benefit when Horizon BCBSNJ and like-minded doctors and hospitals work together to align provider payments with mutually agreed-upon goals for achieving and measuring improvements to patient health. “Horizon and our provider partners are able to achieve better outcomes together because we freely exchange knowledge and expertise, and we share claims data and resources that help doctors better understand their patients and our members. We also all believe that by working together as a team, versus separately in silos, we have the best chance at delivering better care, a better patient experience and lowering costs for the patients we serve,” Karp said.

Horizon BCBSNJ provides care coordination and shared savings payments to doctors and organizations led by health systems that participate in one or more of its value-based programs. In 2018, these value-based payments totaled $100.8 million. Approximately 61% of the total amount Horizon BCBSNJ spends on medical care goes to value-based doctors and hospitals.

When comparing results of Horizon BCBSNJ members engaged with a patient-centered practice to results of members with non-value-based practices, value-based attributed members in 2018 experienced a:

  • 6% higher rate of breast cancer screenings
  • 4% higher screening rate for cervical cancer

The 2018 results also revealed substantial progress from 2017 to 2018 in the quality of care for over 100,000 children who are attributed to one of 74 practices participating in Horizon BCBSNJ’s Pediatric value-based program. For example, year-over-year comparisons for these patients show a:

  • 11% increase in adolescent immunizations
  • 9% increase in weight counseling and monitoring visits
  • 21% increase in child well visits

“Horizon’s Value-Based program enables a large organization like BCD Health Partners to easily collaborate, share data, maintain a high clinical quality standard for our patients and achieve our goals,” said Jill Stoller, MD, FAAP, President & CEO of BCD Health Partners LLC, which participates in Horizon BCBSNJ’s Pediatric value-based program. “The well-defined clinical information we receive through our partnership with Horizon allows us to regularly review our performance and understand how we can achieve and outperform the quality outcome objectives we set for our patients. We see even greater potential for improving patient care quality as Electronic Medical Records capabilities improve and the data we share with Horizon becomes even more defined and precise.”

Don Liss, MD, Vice President and Chief Medical Officer for Horizon BCBSNJ noted that in addition to year-over-year quality improvements among pediatric members, patient-centered pediatric practices are also outperforming national standards of quality, as measured by Healthcare Effectiveness Data and Information Set (HEDIS) scores. The 2018 results show that 7% more 2-year-olds received their vaccinations compared to the National 50th Percentile of HEDIS, while 14% more adolescents were immunized.

“Wellness and preventive care are hallmarks of the patient-centered approach,” Liss said. “Whether we’re working with a pediatric practice to help ensure that children are immunized, or working with other specialists and hospitals to coordinate the care necessary to keep all our members well, Horizon and our patient-centered providers understand the power of preventive medicine.”

More than 4,500 primary care physicians and thousands of other doctors, specialists and health care professionals participate in Horizon BCBSNJ’s value-based programs. Horizon has several value-based care initiatives including the OMNIA Health Alliance, Accountable Care Organizations, Patient-Centered Medical Homes, and Episodes of Care.

About Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey, the state's oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving approximately 3.4 million members.