Transforming health care in New Jersey

Published October 26, 2015

According to a recent report from the National Association of Insurance Commissioners, New Jersey residents have the distinction of paying the second highest health care costs in the country. In addition, New Jersey’s health care costs are cited as rising 25 percent faster than the national average. Individuals and businesses feel the crushing burden of these costs and they are asking for relief.

Since the implementation of the Affordable Care Act, we’ve heard from our customers and employers across all markets that they are looking for greater value in health care -- lower costs, improved patient outcomes and enhanced patient experiences. The traditional, fee-for-service health care system that generally treats patients when they are sick, and pays hospitals and doctors for the volume of services provided, results in high costs that are unsustainable and have little impact on improving quality. Coupled with changes in the post-health care reform marketplace and the accelerating pace of consolidation among hospitals and doctor groups, Horizon Blue Cross Blue Shield of New Jersey committed to fundamentally change how health care is paid for and delivered in New Jersey.

For the past several years, Horizon BCBSNJ has worked to develop patient-centered programs, including Patient-Centered Medical Homes, Accountable Care Organizations and Episodes of Care.  To date, the results have been very encouraging – we are seeing improvements in the care our members receive and a positive impact on overall health care costs.   

The latest review of 2014 claims data indicates that Horizon BCBSNJ members in patient-centered practices, as compared to members in traditional practices, have a:

  • 8 percent lower rate in hospital admissions;
  • 5 percent lower rate in Emergency Room visits;
  • 6 percent higher rate of improved diabetes control; and
  • 7 percent higher rate in cholesterol management for diabetic patients; and a
  • 9 percent lower total cost of care.

In September, Horizon BCBSNJ was pleased to announce the OMNIA Health Alliance, a joint effort of health care leaders across New Jersey with a shared vision and commitment of both intellectual and financial resources to accelerate New Jersey’s change from the traditional fee-for-service system to one where hospitals and doctors are rewarded for the quality, not the quantity, of care they provide to our members. This alliance will accelerate the shift away from the traditional fee-for-service system to one that rewards hospitals and doctors for high-quality care, a better patient experience and lower cost of care. The new, collaborative approach is in response to consumer demands to change the status quo and provide employers and consumers with affordable, high-quality health care over the long term.

This month, Horizon BCBSNJ will offer our customers our full portfolio of plan offerings, which will include our new OMNIA Health Plans. OMNIA Health Plans have lower premiums and give members the choice to receive care from all doctors and hospitals participating in the plan, with the ability to save on out-of-pocket costs when receiving care from designated doctors, hospitals and other health care professionals. 

Transforming health care in New Jersey is a big goal. Through innovation and collaboration and a willingness to reject the status quo, we will achieve this. A better health care system is on the horizon.