Affordable healthcare is needed today more than ever. But long before today’s crisis, Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has been teaming up with doctors and hospitals to work on lowering costs for our members. Here are 10 ways we’ve done it so far.
While the pandemic raised the volume, cries for relief from ever-increasing costs have been part of the dialogue about the future of healthcare for decades.
To help make sure a COVID-19 diagnosis didn’t translate into extra financial hardship, health insurers like Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) stepped up to waive out-of-pocket costs for testing and treatment. For those unaffected by the virus, but in need of care for routine health issues, Horizon BCBSNJ eliminated cost-sharing for telemedicine.
But, pursuing more affordable healthcare for its members isn’t new for New Jersey’s top health insurer. Horizon BCBSNJ has been at it for more than a decade and we come at it from every angle you can imagine.
At the heart of Horizon BCBSNJ’s efforts is patient-focused care that focuses on improving quality as the path to lowering overall costs. By aligning its goals with like-minded doctors and putting patients first, Horizon BCBSNJ is able to help shift New Jersey’s healthcare system toward providing better care at lower costs.
This is accomplished in several ways. For one, we make it easier for members to find the right care and access lower-cost options. And second, we help doctors better coordinate whole-person care – mind and body – while enabling them to share in the savings when they reach agreed-upon goals around quality, member experience and cost.
Some of these initiatives directly lower costs for members, whiles others work behind the scenes to keep costs across the healthcare system from rising as much as they otherwise could. Together, they help Horizon BCBSNJ be more efficient and Horizon BCBSNJ members get more out of their benefits.
Here are 10 ways we’re working with members and our healthcare partners to drive more affordable care in New Jersey.
Member-focused efforts
- No-cost care when it matters most. When the pandemic hit, Horizon BCBSNJ delivered relief to its members in the form of no-cost diagnostic testing, telemedicine visits and treatments connected to COVID-19. What’s more, Horizon BCBSNJ supports members through life’s challenges with many services that require no additional costs – from immunizations for children to customized health coaching, and regular screenings and annual physicals.
- Helping members find affordable care that’s right for them. Choosing the right place to get care can save members time and money. That’s why we educate members whether to have an urgent care or telemedicine visit vs. going to the ER when appropriate. And with our out-of-network cost calculator, members can plan for anticipated costs based on the type of care or procedure they receive.
- Lowering the cost of prescription drugs. Drug costs can add up quickly, especially for brand-name medicines. We help doctors choose effective, lower-cost generic alternatives, providing them with members’ benefits information and out-of-pocket costs. When doctors use this new software, patients could potentially save up to $250 or more with each prescription filled.
While generic medicines generally cost far less than brand-name medicines, there are exceptions. Horizon BCBSNJ has partnered with a non-profit that plans to work with trusted, FDA-approved drug manufacturers to produce quality medicines that can compete with these high-priced generics. This first-of-its-kind partnership is setting the stage for lower drug prices down the road.
- Prioritizing mental health and substance use treatment to avoid costly consequences. Overlooking mental health and substance use issues can lead to poor overall health, a potentially dangerous and costly outcome. Over the past few years Horizon BCBSNJ has increased access for mental health and addiction treatment programs, an effort that was expanded and accelerated during the pandemic. Members can now easily connect with licensed therapists online or sign up for innovative medication-assisted treatment for addiction. In one program for members struggling with opioid use disorder, adherence rates beat those of traditional treatment by 60 percent, for one-tenth of the cost.
- Building healthier communities to stop costly conditions from growing. Housing, affordable healthy food and access to reliable transportation – so-called social determinants of health – can impact a person’s health as much as seeing a doctor. Our Community Health model links members to community resources to overcome these barriers and helps them navigate the healthcare system to get the care they need for preventable or chronic health conditions. Catching and addressing health problems early on helps avoid costly complications later on.
- Providing plan options with lower premiums. Members don’t have to choose between more organized, personalized and coordinated care and affordable care. With an OMNIASM Health Plan, members who choose designated doctors and hospitals, while still having access to Horizon BCBSNJ’s large provider network, get the benefit of patient-centered care and lower out-of-pocket costs. Premiums for OMNIA programs are 15 percent less expensive, on average, than comparable plans.
Healthcare professional-focused programs
- Rewarding doctors for better quality to spread savings for all. To increase efficient, quality care, the healthcare system must move away from rewarding more tests and procedures over better health outcomes. Our innovative Episodes of Care program makes this move in a big way. It puts doctors in charge of coordinating all care for a specific medical condition or procedure, giving them responsibility for ensuring patients receive the best quality and most appropriate care possible. If the doctors successfully meet certain quality and cost targets, they share in the savings achieved.
- Coordinating physical and mental health services for better, more efficient care. We help doctors easily identify patients with undiagnosed mental health or substance use challenges that may be tied to a medical condition – and then connect these patients to qualified, local in-network specialists. Patients get the right care at the right time, and doctors get the support they need to make it happen.
- Painting complete picture of patient health to promote cost-effective care. A flurry of doctor visits, diagnoses, prescriptions and lab work can make for a disjointed healthcare experience. We can provide doctors with a 360-degree view of all this information so they can provide the best care to our members. This transparency helps ensure patients follow their doctors’ care directions, prevents duplicate procedures and tests, and holds doctors accountable for meeting quality standards and delivering cost-effective care.
- Helping manage complex, costly conditions. People with both physical and mental health conditions make up a higher proportion of healthcare expenses, so it makes sense to treat them holistically. As part of our first-of-its-kind Integrated System of Care pilot program, we partnered with a local behavioral health agency to coordinate all kinds of physical, mental health and substance use care members need to stay healthy. This integrated approach drives down the total costs of care by, for example, reducing ER visits and hospitalizations.
Most of the programs are available to all Horizon BCBSNJ members, but check your benefits to determine eligibility.
Thomas Vincz is public relations manager at Horizon BCBSNJ. Horizon BCBSNJ, the state’s oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of healthcare in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at HorizonBlue.com
