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Horizon to Fund New NJ Healthcare Advocacy Organization

State’s largest health insurer is backing a group whose goal is to ‘educate consumers,’ a promise welcomed by some, greeted with a raised eyebrow by others

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Horizon Blue Cross Blue Shield, the state’s largest health insurer, has agreed to fund a new advocacy organization comprised largely of business and labor groups in an effort to educate consumers on New Jersey’s evolving healthcare system and seek public input on how to improve this changing landscape.

Leaders of Better Choices, Better Care NJ, who announced the new organization Monday at a press conference in Trenton, said patients are confused by new healthcare payment models and other developments. They also noted that consumers are struggling to keep pace with rising healthcare costs, and suggested that government officials often lack the baseline information they need to implement effective policy.

The new organization’s executive director Christine Stearns said the group intends to spread its message through opinion-editorials, policy meetings, public forums, online posts and social media; its website also invites visitors to “share their story” about healthcare.

While several healthcare advocates welcomed the new group to the conversation, some also raised questions about the organization’s composition and Horizon’s role in it. An honest discussion and real reform requires direct input from healthcare providers, including hospitals, and true consumer representation — voices currently lacking in the Better Choices panel, they said.

Stearns said the group has been very transparent about its connection to Horizon and is still working out the funding details; its steering committee members all serve without compensation. The goal was to assemble a diverse group with “real interest in the topic” and a shared goal of educating consumers, explained Stearns, who leads government affairs work for Gibbons, P.C, a law firm that works closely with Horizon. The panel also includes business representatives, labor leaders, a primary care physician and a senior Horizon executive who is also a doctor. Stearns said it had no immediate plans to get involved with specific legislation, but instead seeks to spark a wider conversation.

“Consumers have not been engaged and we need to communicate to them about what we’re doing,” said Laurel Pickering, president and CEO of the Northeast Business Group on Health, which works with large companies that are self-insured. Many are confused about new terms and models, like value-based care — which rewards providers for better health outcomes, as opposed to the volume-focused fee-for-service system it is replacing — “and they have no idea we are doing this for them,” Pickering said.

Horizon, which insures some 3.8 million New Jersey residents, has invested heavily in programs designed to support value-based care, sometimes known as patient-centered care, which can keep patients healthier while also curbing rising healthcare costs. In 2015, these efforts helped avoid some 3,500 emergency room visits and generated nearly $60 million in savings, which was shared among the participating providers.

But these efforts are just beginning to take effect and healthcare prices continue to climb. More than two-thirds of Garden State residents are concerned about the cost of care, according to polling and focus groups conducted by Better Choices, and healthcare costs remain a primary concern for many businesses, small and large. Insurance costs have jumped from 6 percent to 25 percent of his union’s spending, noted panel leader George Laufenberg, director of the Northeast Carpenters Fund.

“Being in business, predictability is incredibly important,” said John Harmon, president and CEO of the African American Chamber of Commerce of New Jersey, which represents some 66,000 black-owned businesses. “And we want better values for the money we are spending.”

Healthcare value is another widespread concern among patients and consumers, Better Choices research found. While patients tend not to blame their doctors, most said the system “prioritizes testing over wellness” and would prefer a model that allows providers to invest more time and personal attention in each patient. Several members recounted personal stories of wasteful healthcare spending or missed opportunities for better care.

“Core to my belief is that we as a state can do better,” said Dr. Minal Patel, a senior vice-president for strategy at Horizon who described his own father’s diagnosis and sudden death from cancer, at age 63. “New York and Philly, sometimes we live in their shadows, but from a clinical and medical standpoint it doesn’t have to be that way anymore.”

Better Choices has been under development for nearly a year, supporters said, prompted in part by the significant controversy surrounding Horizon’s OMNIA plan, which offers patients steep premium discounts in exchange for visiting providers in a select group, or tier. While the product has proved popular with consumers, it has drawn fire from hospitals not included in the preferred tier.

Although there are no immediate plans for the new organization to talk about OMNIA, or consumer trade-offs in general — like limiting provider choices, increasing out-of-pocket costs or other tweaks designed to hold down costs — several said that could eventually be part of the conversation. “First we need to figure out what consumers don’t understand,” Pickering said. “But I could see that being part of the messaging as we sit and figure out how to communicate this.”

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute — which involves several of the same leaders and has pursued a similar mission since it was founded nearly two decades ago — praised Better Choices’ “lofty goals” and welcomed them to the table. “There’s no shortage of work to be done here,” she said.

The institute has applied a slightly different approach, Schwimmer explained, including a number of hospital and physician representatives among its leaders to ensure that providers are fully engaged in the conversation. “You can’t just squeeze cost out of the system without all those voices,” she said.

Dave Knowlton, the institute’s founder, agreed there is “room for everyone” at the table. But he said disclosure of Horizon’s role in the group is essential for a constructive dialogue. “Large entities in healthcare spend their time trying to educate consumers for the good of their health,” he said, “but very often it is also in their self-interest.”

But Maura Collinsgru, the healthcare director with Citizen Action, said the news sparked concerns for leaders of NJ For Health Care, a grassroots coalition she chairs that includes labor, business and patient advocates. “While insurers are a valuable partner at the health reform table, they cannot lead the charge to combat high health care costs,” she said, stressing that real reform must be consumer-driven. “Business and labor payers should join with consumer groups to work together toward affordable health care solutions rather than rely on insurers to work together toward affordable health care solutions.”

Better Choices’ steering committee also includes: Eric Boyce, with the Plumbers and Pipefitters National Pension Plan; Tom Bracken, president of the New Jersey Chamber of Commerce; Lizette Delgado-Polanco, state council director of the Service Employees International Union; Dr. Joyce Nkwonta, a primary care physician from Plainfield; and Michele Siekerka, president and CEO of the New Jersey Business and Industry Association.

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