What does it take to achieve member-centric, value-based care in population health? At a conference in New Jersey on Thursday, speakers talked about using partnerships and data to solve challenges, especially ones made worse by poor social determinants of health.
Allen J. Karp, MBA, the executive vice president of healthcare management and transformation at Horizon Blue Cross and Blue Shield of NJ, detailed the path the insurer has taken over the past 7 or so years to break down silos in an effort to lower costs while improving health.
Karp gave the plenary address at the 68th Annual Roy A. Bowers Pharmaceutical Conference at the Ernest Mario School of Pharmacy at Rutgers University.
“Member centric means meeting patients where they are,” Karp said, recalling how care management used to work in the not-so-distant past. For instance, if a patient left the emergency department with care instructions, they might get separate calls afterwards from their provider, the insurer, and maybe the hospital.
“Then they’re confused and they don’t know what to do and, therefore, they do nothing,” he said, of the effect of duplicative efforts resulting from all healthcare stakeholders being disconnected from each other.
Horizon is forming partnerships with providers, digital firms, and the community, he said, as a way to “bring the best out of each partner.”
In one New Jersey health system, Horizon is partnering to put patient navigators in the ED; the navigators meet with patients face to face, ensure that there is a tightly coordinated care plan, obtain needed medication, and even drive patients to a follow-up physician appointment, he said.
In Newark, New Jersey, Horizon and RWJBarnabas Health collaborated to pilot 2 community workers in 4 zip codes in a low socioeconomic area. The 1000 commercial members had healthcare costs of $14 million a year. The community health workers, who lived in the same neighborhoods, helped connect members with the resources they needed to stay healthy. For example, one man received assistance with getting a mortgage, and another needed help affording medications so that his chronic conditions would no longer lead to ED visits 3 to 4 times a week.
The results led to a 25% reduction in the total cost of care and a 24% reduction in ED visits. Horizon plans to expand the program throughout Newark and 75 zip codes with similar demographics throughout the state, Karp said.
In the digital arena, Karp showed how Horizon is using a mobile app from the health technology company Pager to give consumers the ability to chat with a nurse, make an appointment, or use telemedicine on their phone. It also alerts patients if the provider is running behind, so they can time their travel or reschedule. Karp called it an example of high-touch, high-tech care.
Date: November 9, 2018