Value-based care makes up 60 percent of Horizon payments in New Jersey
In 2015, patient-centered practices and hospitals received $58.9 million in care coordination and shared savings payments.
Horizon Blue Cross Blue Shield of New Jersey's headquarters in Newark.
Value-based payments are working for Horizon Blue Cross Blue Shield of New Jersey, as the company reported close to 60 percent of its medical claims spend last year went to patient-centered network doctors and hospitals.
In 2015, patient-centered practices and hospitals received $58.9 million in care coordination and shared savings payments for reaching quality and savings goals.
These value-based payments were in addition to what the providers were paid through traditional fee-for-service reimbursements.
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More than 4,100 primary care network doctors and thousands of specialists in 2015 received a total of $28.9 million in care coordination fees and $30 million in shared savings for a total of $58.9 million in value-based payments, Horizon BCBSNJ said.
Since 2013, the insurer has made $125 million in value-based payments to its patient-centered providers.
In 2015, ER visits decreased by more than 3,500 in 2015, resulting in a projected savings of over $2.6 million.
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Practices helped members avoid more than 400 inpatient stays, saving more than $4 million.
"Patient-centered practices are not only helping Horizon members better manage and prevent diseases, they're helping to bend the healthcare cost curve by reducing unnecessary ER visits, inpatient admissions, duplicative testing and other inefficiencies that don't contribute to better care quality," said Allen Karp, senior vice president, Healthcare Management for Horizon BCBSNJ. "Patient-centered care is delivering real results for our members in terms of improved quality outcomes and it is lowering the overall cost of care."
For 2015, Horizon BCBSNJ reviewed claims data for members receiving care from a patient-centered provider and compared those findings to members receiving care from traditional providers.
The results showed a 12 percent lower cost of care for members with diabetes; a 2 percent higher rate in breast cancer screenings; a 5 percent lower rate of emergency room visits; and a 2 percent lower rate of hospital admissions.
An estimated 1 million members benefit from patient-centered programs, the insurer said.
The personalized care includes the use of care coordinators; wellness and preventive care; extra wellness support and education; active patient monitoring and communication from the doctor and care coordinator; and coordination of a patient's care with specialists and other providers.
Twitter: @SusanJMorse
