Aledade, Horizon to Reach NJ Primary Care Practices in New ACO

Aledade and Horizon Blue Cross and Blue Shield of New Jersey partner to help practices take advantage of payment models that reward physicians who offer better quality care while lowering costs.

Aledade, which helps primary care practices make the leap to value-based care with regulatory and technical support, has signed an agreement with New Jersey’s largest health insurer to assist providers through an accountable care organization (ACO) that will serve 20,000 patients.

Horizon Blue Cross and Blue Shield of New Jersey, which served 3.8 million members, announced the agreement Tuesday with Aledade. The contract represents Aledade’s first commercial contract in New Jersey; it currently works with providers in 15 other states affecting 360,000 patients. Aledade also plans to expand to Ohio and Kentucky in 2018, according to a statement.

According to Horizon spokesman Tom Vincz, the agreement is part of the insurer’s broader value-based care strategy, which includes episode-of-care models, a new oncology care pilot announced earlier this year with Regional Cancer Care Associates, and its OMNIA health plans and partnerships, which give patients cost savings for staying in a network of certain hospitals and physicians; separately, providers in the OMNIA partnerships have reached value-based agreements with Horizon.

Aledade was founded by Farzad Mostashari, MD, the former National Coordinator for Health Information Technology and a former guest editor of the annual Health IT issue of The American Journal of Managed Care®. Aledade strives to provide the data analytics and population health management for primary care practices that want to stay independent as healthcare moves away from a fee-for-service model. Smaller practices may lack the infrastructure to handle the reporting requirements needed to take part in new payment models proposed by CMS, which has led many to close or merge with larger health systems. Regulatory burdens are cited in several recent reports on physician burnout, contributing to the shortage of primary care physicians, even though these “quarterbacks” are considered key to care delivery in the future.

The agreement between Aledade and Horizon will help practices take advantage of payment models that reward physicians who offer better quality care while lowering costs. “Our new agreement with Horizon is an exciting opportunity to advance value-based care and to improve the health of thousands of New Jersey patients,” said Dan Bowles, vice president of provider networks for Aledade. “In collaboration with local primary care practices, our innovative physician-led model will drive improvements in quality and patient outcomes through more personalized, coordinated care.”

The contract calls for Aledade’s New Jersey ACO, which will cover practices across central and northern New Jersey to “take accountability for the total healthcare experience of Horizon members who see them.” So far, however, these agreements do not call for 2-sided risk, which would expose practices to losses if they failed to meet targets, according to a spokesman for Aledade. Experts in value-based agreements say that while programs have started to gain traction, physicians have been slow to move from earning bonuses to taking on risk.

“This collaboration with Aledade is another example of how Horizon is working closely with doctors and hospitals to improve healthcare, lower costs, and deliver better outcomes for our members,” said R.J. Franzoi, Horizon’s vice president for Health Care Delivery.