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Horizon BCBSNJ Reports 10% Rise in Value-Based Payments


For 2017, New Jersey's largest insurer made particularly good progress in certain diabetes measures and in cancer screenings.

New Jersey’s largest health insurer has reported a 10% jump in value-based payments to physicians for 2017, driven in part by more cancer screenings and fewer trips to the emergency department for people with diabetes.

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) announced total payments were $104 million, on top of fee-for-service payments. These payments covered savings for episodes of care, contracts with accountable care organizations (ACOs), and the OMNIA Health Alliance, which are long-term relationships that Horizon has 6 large health systems in the state.

In its statement, Horizon noted that 70% of its in-network primary care physicians are involved in some type of value-based program. That share has climbed 20% over the past 2 years. In an appearance last week with the Institute of Value-Based Medicine, a program of The American Journal of Managed Care®, Horizon BCBSNJ Executive Vice President for Healthcare and Transformation Management Allen Karp said that more than 1000 specialists, including oncologists, also take part in value-based programs, and that some will take part in “prospective” models come January 1, 2019.

“Horizon began engaging doctors in value-based care collaborations nearly a decade ago and these results confirm that it is our members—their patients—who benefit most when we create a strong partnership and work as a team to provide the care they need,” Karp said in a statement. “The question is no longer whether to pursue value-based partnerships, it is which models deliver the best quality improvements, the best patient experience and are most effective at lowering an individual’s total cost of care.”

Overall, members who received care from value-based care providers produced a 4% lower total cost of care trend compared with all commercial members. Horizon also reported that members who providers in value-based programs had a 4% lower rate of hospital inpatient admissions, a 6% higher rate of colorectal cancer screenings, and a 7% higher rate of breast cancer screenings.

In particular areas that drive healthcare costs, including patients with diabetes, the results were even better. Compared with the entire commercial membership, patients seeing value-based providers experienced:

  • A 24% lower rate of 30-day readmissions among patients with diabetes.
  • An 11% improvement in diabetes management, based on 4 Healthcare Effectiveness Data and Information Set (HEDIS) metrics, which were testing for glycated hemoglobin (A1C), share of population with A1C < 8%, eye exams (retinal), and medical attention for nephropathy.
  • A 6% lower medical cost trend for patients with congestive heart failure.
  • A 2% reduction in potentially avoidable emergency department visits, year over year. This measure is based on a validated algorithm developed by New York University.

According to Thomas R. Graf, MD, Horizon BCBSNJ chief medical officer and vice president for healthcare transformation, the calculations also adjusted for demographic, socioeconomic, and health risk factors, as well as the effect of high-cost outliers.

“The better outcomes and lower costs demonstrate that a health insurer like Horizon can have a very different kind of relationship with its network doctors and hospitals, and that working together fulfills our common commitment to do what is best for our patients and members,” Graf said.

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