Improving Cost, Quality, and the Patient Experience is Horizon’s Path to Better Health Care
Through the Triple Aim, we are focused on providing real value for our members: delivering just the right care at the right time and in the right place for a quality outcome.
By Kevin Conlin, President & Chief Executive Officer
Several years ago, the Institute for Healthcare Improvement developed a framework to help improve the performance of the U.S. health care system. This framework, which has become known throughout the industry as the Triple Aim, calls on health care organizations to focus their efforts in three areas:
- Reduce the per-person cost of healthcare
- Improve the health of populations
- Enhance the individual experience of care
The Triple Aim has touched a chord across the industry, including here at Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). In fact, our mission is fully aligned with the Triple Aim: “We empower our members to achieve their best health by leading with strength, integrity and innovation to generate substantial improvements in health care quality, affordability and member experience.”
We are dedicated to this mission of service to our members and recognize that our industry needs to do more to address the critical issues raised by the Triple Aim.
Facilities like Sanitas Medical Centers make it more convenient for our members to obtain personalized care in their own community.
Take cost, for example. The U.S. spends more on healthcare than any other high-income country. In 2017, healthcare expenditures here were nearly twice what comparable countries spend, and in New Jersey health care costs are rising faster than the national average.
Despite all this spending, healthcare outcomes in the U.S. often lag those of most other high-income countries. Even more concerning, significant disparities in health exist due to race, income and other factors. For example, New Jersey averaged 4.7 deaths per 1,000 births in 2015, but that rate doubles to 9.7 deaths per 1,000 births for African-American babies. New Jersey ranks 47th in maternal deaths --deaths during pregnancy or within a year of giving birth – the third worst in the nation.
Governor Murphy and First Lady Tammy Murphy deserve credit for shining a light on the issue of maternal health and making the elimination of disparities in care due to race or ethnicity one of their signature health care initiatives. We are proud to support these efforts and are working with many provider groups to address these gaps.
The way consumers experience healthcare in the U.S. also gives cause for concern. In the one-click world of Amazon and Uber, our healthcare delivery system remains highly fragmented. The result: consumers often face a blizzard of paperwork, endure long wait times to see a physician and, all too often, undergo costly tests and procedures that contribute nothing to their health.
Inside a pediatric exam room at a Sanitas Medical Center, a one-stop solution to patients’ everyday health needs.
As a country, we must do more to address the issues of affordability, quality and patient experience that are the focus of the Triple Aim. At Horizon BCBSNJ, we are committed to making a significant impact in each of these three areas so our members can, indeed, achieve their best health.
We have learned, however, that it is not enough to tackle these issues separately. Under the Triple Aim, cost, quality and patient experience are so tightly interconnected, they need to be addressed holistically.
Our Triple Aim approach therefore starts with our members and centers on the concept of value – implementing changes that improve health outcomes while lowering costs or making it easier for members to obtain the care they need to enhance their overall health.
A great example is our Episodes of Care (EOC) program. EOC is a value-based model in which a physician defines and manages all aspects of care related to a specific medical condition, illness or procedure – a hip replacement, for example, or surgery for prostate cancer. The lead physician oversees all other care givers and is responsible for ensuring the patient receives the most appropriate, high-quality and cost-effective care.
Some 26 different treatments are now included in the EOC program, and last year more than 38,000 episodes were recorded – resulting in a savings of $43.8 million.
The Episodes of Care program provides treatments that result in major savings.
But the EOC program is not only cost effective, it improves quality as well. New Jersey, for example, has historically had the highest rate of Cesarean sections (C-sections) in the country. C-sections are inherently more risky than a vaginal birth, and yet, for a variety of reasons, they were becoming increasingly commonplace across the state.
Working with RWJBarnabas Health, we developed a pregnancy episode that removed the incentives for performing a surgical delivery and focused on the successful term delivery of a healthy infant. This more flexible model, which encourages practices to continually assess the health and welfare of the mother and baby, has consistently reduced the rate of C-sections.
A key lesson here is that focusing on value does not have to mean reducing care or accepting lower quality. It means delivering just the right care at the right time and in the right place to ensure a high-quality outcome in the most efficient way possible. Indeed, the tools we are employing to improve quality are the same ones that reduce costs while offering our members new tools to improve the way they obtain care or use their health insurance benefits.
All of us at Horizon BCBSNJ are excited by the power and promise of the Triple Aim. Over the next few months, we will examine each of its elements – cost, quality and patient experience – in more detail and share our thoughts with you. We welcome your input to this dialogue.