12:46 PM

Making the Future of Health Care Happen



By Kevin Conlin, President & Chief Executive Officer

“Health care in America is changing.”

As CEO of Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ), I have made this point hundreds of times.

But the truth is – from the standpoint of the growing expectations of our members and consumers across the country – I do not think health care in America is changing nearly enough.

At Horizon BCBSNJ, we are committed to improving health care for our members, right here in New Jersey. They are at the core of everything we do. They are why we have introduced high-quality insurance plans for our members and have championed initiatives to make health care more affordable and accessible. They are why we have helped thousands of doctors and hospitals transition to new ways of doing business that reward better outcomes – particularly for the 1.6 million Horizon BCBSNJ members who are already enrolled in these value-based programs. And they are why we have made it easier for our members to manage their health through new telehealth solutions and our integrated mobile platform.

But as health care continues to evolve, so do our customers’ needs and expectations. Delivering new technologies, new services and more affordable coverage requires a new approach to our legal structure – one that will provide us with more flexibility to make investments in products and services that our members are demanding.

Right now, we operate as a not-for-profit health services corporation – a unique corporate structure that traces its roots back more than 80 years to when we were founded. Although this structure has served our members well, it limits our ability to invest and innovate in ways that today’s health care landscape requires. Restrictions include:

  • Strict limits on the size of investments we can make regardless of their benefit to our members.
  • A ceiling on business outside of traditional commercial insurance services even for critical services provided to the State including Medicaid.
  • The inability to use a modern holding company structure commonly used by health insurers and important to facilitating investments that help our members.

Changing to a new structure would allow us to better keep health care costs under control and bring better health outcomes to New Jersey residents. What we are proposing is a technical, but important, change to modernize Horizon’s legal structure by becoming a not-for-profit mutual so we are better positioned to make health care work the way our members want it to. With greater strategic and operational flexibility, we would be able to accelerate investments in technologies and innovations that improve health care quality, cost and convenience.

Becoming a mutual may seem like a big change, but the mutual structure has already been adopted by Blue Cross Blue Shield plans in 18 other states. As a mutual with a modern-day structure, we would be able to work harder for our members. It would mean:

Greater investments in new, consumer-friendly technologies such as expanded access to telemedicine so members would have greater convenience to consult a doctor.
New models of care that address social and economic barriers to positive health outcomes.
More web- and mobile-based tools to keep health care costs under control, including prescription drugs critical to our members’ health.
On-demand services to help our members navigate critical issues like substance abuse and mental health.

What would not change under a mutual structure is Horizon BCBSNJ’s commitment to our members – our No. 1 priority. The change would preserve the not-for-profit status that has been at the core of who we are and what we have done for the past 87 years. We are extremely proud of this heritage and focused on returning value exclusively to our members, not outside investors or stockholders.

We have always been deeply committed to New Jersey. We employ over 5,000 New Jersey residents – 75 percent of whom are women and 50 percent of whom are minorities. We pay more than $200 million in state taxes each year. And the Horizon Foundation for New Jersey has provided more than $56 million in grants that support the health and well-being of New Jersey residents.

This transition to a mutual structure would further boost our contribution to New Jersey.

According to an independent study from EConsult Solutions Inc., this simple change would generate approximately $4.16 billion in new economic output over the next 10 years and support approximately 2,000 full-time jobs from both Horizon and related industries. The added economic activity would be generated through investments in operations and new technologies enabled by this change.

For Horizon BCBSNJ to become a not-for-profit mutual, the state legislature would need to pass a new law. Similar laws already exist in more than half the states. Doing so would help advance our mission to empower our members to achieve their best health, while investing in the health and wellness of New Jersey’s communities. It would also level the playing field by removing barriers that apply exclusively to our company, New Jersey’s only not-for-profit insurer.

At Horizon BCBSNJ, we are serious about bringing together doctors, hospitals, employers and patients to create a system that is more affordable, promotes better results and meets the needs of today’s consumer. That is why we are pursuing this change.

Our members are expecting more from health care today. It is time to modernize our structure so we can continue to meet their expectations well into the future.

Learn more at HorizonForYou.com