A new partnership bringing together the state’s largest health insurance plan and its largest healthcare delivery system signals a new focus on coordinating the care of elderly patients in New Jersey.
The accountable care organization (ACO) announced by Horizon Blue Cross Blue Shield of New Jersey and Barnabas Health is a landmark event in the growth of the new approach to healthcare delivery in which insurers pay providers to better coordinate care in order to reduce unnecessary tests and treatments while aiming to have no drop-off in the quality of care.
The ACO arrangement between the two health giants is scheduled to begin September 1 for patients covered by Horizon’s Medicare Advantage plan, a private health plan that provides Medicare services.
“What we know is we need to enhance the communication among and between all parties who work to advance healthcare for patients,” and the ACO puts the system in position to do that, said Dr. Anthony Slonim, Barnabas’ chief medical officer and executive vice president. “When you have the largest delivery system and the largest payer working together to solve challenges, only good can come from that.”
Slonim described the ACO as a way “to think differently about the way we provide care to populations of patients,” with “populations” being the operative word. Instead of measuring the health outcomes of individual patients, the ACO will measure whether it is providing needed services to entire groups.
Slonim said he hopes patients will experience “a new and improved level of service,” including getting more feedback from Barnabas staff about how the patients can participate in their own care. For example, when a patient is hospitalized with a chronic condition, the Barnabas staff will be paid under the ACO to help the patient schedule appropriate care after being released.
Slonim said providing the increased level of service “will take thinking and coordination and perhaps staff member education.”
Another key feature of ACOs is that providers will share in savings that result from the coordinated approach.
Horizon Vice President Jim Albano, who oversees Horizon Health Innovations and network management, said in a statement that the arrangement underscores the companies’ mutual desire to transform care delivery.
“Collectively, these accountable care innovations inject a new level of collaboration and quality standards into our health delivery system and help remove wasteful, unnecessary costs,” he said.
A Horizon spokesman said the ACO is part of a broader “patient-centered” approach that is transforming the company’s payment structures from fee-for-service, in which providers are paid for each service they provide, to “pay-for-value.”
He said Barnabas and its doctors are taking on more accountability, since their pay will depend in part on whether outcomes improve while costs are controlled.
“Simply put, Horizon wants to reward the health care leaders who deliver better outcomes and more efficient health care to our members,” Horizon spokesman Thomas Vincz said.
The ACO is Horizon’s fifth announced over the past 12 months, and the company plans to continue to expand its patient-centered programs with providers, Vincz said.
In July, Horizon announced that it saw benefits in 2012 from its patient-centered medical home program its patient-centered medical home (PCMH) program, which – similar to ACOs – include payments for increased care coordination.
Participants in the program had a 3 percent higher rate of breast-cancer screenings, an 11 percent higher rate of pneumonia vaccinations, a 23 percent lower rate of hospital inpatient admissions, a 12 percent lower rate of emergency room visits, and a 9 percent reduction in the cost of care for diabetic patients.
Horizon officials see these results as boding well for the Barnabas ACO.
“Patient-centered primary care is the core foundation for both PCMH and ACO programs,” Vincz said.
Barnabas was approved by the federal Centers for Medicare and Medicaid Services for a separate ACO in July 2012. Slonim said the healthcare system has been building the infrastructure for that ACO over the past year but it’s too early to measure results.