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Horizon’s Patient-Centered, Value-based Programs Continue Growth in 2016 With Top Performers Delivering Dramatically Better Outcomes Producing Lower Costs

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced today that 1.5 million members participated in patient-centered programs in 2016, an increase of 50% over the previous year. The number of primary care physicians participating also grew by nearly 10% and value-based payments to participating physicians increased by 43%, to nearly $100 million, from 2015. The results continue to demonstrate that patients in those practices are getting and staying healthier.

“Since 2008, Horizon has been collaborating with a steadily increasing number of like-minded doctors and hospitals on innovative ways to change the way health care is delivered and paid for in New Jersey. The 2016 results are more proof that these collaborative partnerships are better for Horizon’s 3.8 million members, better for doctors and hospitals, and a better way to lower overall healthcare costs,” said Allen Karp, Senior Vice President for Healthcare Management at Horizon BCBSNJ. “The results achieved by the practices with the longest commitment to patient-centered care are solid evidence that these models will deliver meaningful quality improvements and cost reductions in the long-run.”

According to 2016 results, when compared to those in traditional practices, members engaged with a patient-centered practice experienced a:

  • 3% lower total cost of care
  • 3% lower rate of Emergency Room visits
  • 3% lower rate of hospital inpatient admissions
  • 5% higher rate for colorectal screenings
  • 3% improved rate of diabetes control
  • 3% higher rate in breast cancer screenings
  • 4% improved control of diabetes costs

Patient-centered practices helped Horizon members avoid more than 2,000 emergency room visits and more than 600 Inpatient stays in 2016.

While patient-centered practices performed better than traditional practices, the most successful patient-centered practices achieved results that demonstrate the potential these programs have to dramatically improve outcomes and reduce costs. When compared to the average for all patient-centered practices, top performers – which tended to be the practices that had been engaged in patient-centered medicine the longest - achieved a 20-42% lower rate of in-patient admissions, 16-27% fewer ER visits, and increased by 9-16% patients screened for breast cancer.

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 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.

Dr. Thomas McCarrick, a family physician with Verona-based Vanguard Medical Group, was among the first to join Horizon’s patient-centered medical home program seven years ago and is a proponent of the transformational impact the value-based approach is having on primary care. “Horizon’s collaborative approach has created the opportunity to think critically about the value of our care, use data to gain insights about our patient population, and then to act on our conclusions,“ said Dr. McCarrick. “Primary care doctors choose this specialty because we are patient focused. Horizon’s approach is aligned with what primary care doctors want to do because it’s ultimately patient centric. Feedback from our patients tells us their experience of care continues to improve year after year.”

The number of providers who participate in value-based payment programs also continues to increase as does the share of Horizon’s total medical spend that is for members engaged in Horizon’s value-based programs. In 2016, 67% of Horizon’s medical spend was for members who received some or all of their care from a patient-centered doctor or hospital.

In 2016, value-based payments to the more than 4,500 primary care doctors and thousands of specialists participating in Horizon BCBSNJ’s patient-centered programs increased by 43% from 2015. Participating patient-centered providers 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 providers.

Horizon’s initiatives are at the fore of a nationwide push toward value-based care. At a recent healthcare forum in Washington DC, American Enterprise Institute Scholar Joseph Antos said that value-based payment models are the way forward noting that “the goal is better health, not more healthcare.1” Antos, who also serves as a Commissioner of the Maryland Health Services Cost Review Commission, has written extensively in Health Affairs and elsewhere on delivery system reform as the best way to make healthcare more efficient ( http://healthaffairs.org/blog/2017/04/20/the-future-of-delivery-system-reform/http://healthaffairs.org/blog/2017/04/20/the-future-of-delivery-system-reform/ opens a dialog window ).

About Horizon Blue Cross Blue Shield of New Jersey

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 more than 3.8 million members.