The results speak for themselves is an oft-repeated phrase. But when it comes to our behavioral health solutions, it’s also the overarching approach that’s headline worthy.

The nation’s behavioral health crisis, further heightened by the pandemic, has brought into sharp focus the cracks and inadequacies in the current system of care, with its patchwork approaches that lack cohesive vision and structure.

Horizon Blue Cross and Blue Shield of New Jersey realized a new approach was in order. We rolled up our sleeves to tackle the barriers and create a model that produces better outcomes and lower costs. The result: proven first in-class, purpose-first, fully integrated health solutions that are fiscally responsible.

Comprehensive, evidence-based solutions that yield results

Research has proven that thoughtfully and effectively integrating physical health and behavioral health significantly improves member outcomes while reducing total cost of care.

We took this to heart when we reimaged what behavioral health should look like for our members back in 2017. We developed a radically different system, one that encompasses comprehensive member-centric, evidenced-based and tech-enabled solutions that drive holistic and integrated care within the health plan and clinical delivery system. 

Our solutions are comprised of three components:

Integrated Clinical Solutions

Like many health plans, our behavioral health business was historically outsourced to a traditional managed behavioral health organization (MBHO). MBHOs, however, usually employ a transactional rather than integrated approach to behavioral health.  In 2020, we took the business back in-house and completely overhauled it, creating a true 360-degree care management and utilization solution that combines the best of physical and behavioral health approaches. Using advanced analytics and predictive modeling, we identify members on the cusp of risk, starting where members are at that moment to facilitate the right care at the right time for the right level of acuity. The program has proven to be cost and clinically effective.

Integrated System of Care (ISC)

ISC is a first-of-its-kind, fully integrated and nationally recognized solution for our most vulnerable members: those with serious mental illness and substance use disorder (SUD) as well as comorbid physical health and social determinant of health needs.

As many in the health care space are aware, these complex patients account for about 5 percent of the total member population and approximately 50 percent of the cost. To prevent these members from falling through the cracks,  Horizon implements the full ISC model in collaboration with local health systems, providers and community organizations to coordinate and oversee care. Our ISC solution has proven to be tremendously effective, realizing financial and clinical outcomes that were once thought to be out of reach.

Enhanced Ecosystem

Recognizing the huge challenges that members face with respect to navigating care and accessing the most qualified providers for their needs, we created a unique, curated ecosystem of 15+ (and growing) innovative, evidence-based outpatient behavioral health solutions. These solutions combine cutting-edge technology with clinically effective treatment to immediately supplement access for members. Members receive care that is specifically tailored to their clinical needs and preferences (virtual/digital/brick and mortar).  Members can access the Enhanced Ecosystem in a variety of ways including via our telephonic and online navigation services.  The Enhanced Ecosystem has supported network growth of over 40% in two years for our members.  

We live by the mantra ‘Behavioral Health IS Health’

We passionately believe in our approach, as evidenced by our results, and we believe other health plans and health systems can embrace this approach too. Together we can collectively impact the lives of people with behavioral health conditions and improve their experience and health outcomes while reducing overall costs. Meanwhile, the clock continues to tick.