The Atlantic Health / Horizon BCBSNJ risk-sharing arrangement applies to approximately 30,000 Horizon BCBSNJ members who are patients of Atlantic Health’s Clinically Integrated Network (CIN), which has been part of Horizon BCBSNJ’s value-based program since 2016. While models that reward health systems for improvement are common, what makes this relationship unique is that Atlantic Health has also agreed to share the cost of care in the event that total costs exceed the agreed-upon targets. The better the outcome for the patient, the better each organization does in achieving its financial goals. By contrast, the shared-accountability arrangement incentivizes Horizon BCBSNJ and Atlantic Health to work more closely together to create models of care delivery that reward high quality, coordinated care. Under fee-for-service, health professionals are paid for the volume of care they deliver – more services, tests, and procedures are the only way a health care provider can increase its revenue. In the traditional fee-for-service model, the health insurer bears almost all of the financial impact for care delivery and reimburses doctors, hospitals, specialists, diagnostic facilities, and others involved in care with little regard for the benefit provided. “This arrangement puts the focus on achieving the best result for the patient by giving doctors more accountability for the care they deliver along with greater incentives for them to help lower the total cost of care.” Hilaire President and Chief Executive Officer of Horizon BCBSNJ. This shared-accountability arrangement is the latest milestone in our progress to achieve this level of alignment,” said Gary D. “The OMNIA Health Alliance launched five years ago with the goals of working together to transform health care in New Jersey and improving health care quality, affordability and experience. I am proud to lead a health system that has entered into a shared-accountability arrangement and hope that our commitment will serve as a catalyst to others, so that together, we can address the major issue of health care costs in our state.” “To support our journey toward value-based care, we have invested in robust data systems that empower our physicians and caregivers to deliver the most precise, personalized care. This unique partnership has created a framework to deliver high-quality, affordable and accessible care that is increasingly proactive and preventative,” said Brian Gragnolati, President and Chief Executive Officer of Atlantic Health System. “Health care is a team effort, including how we pay for care. Furthermore, these efforts to improve quality and the consumer experience have resulted in a 5% reduction in the total cost of care for patients/members in the first program year. This innovative and successful arrangement has resulted in a reduction of more than 9% in unnecessary hospitalizations and, correspondingly, better overall health outcomes for those involved. To achieve this, the partners collaborated in new ways to enable Atlantic Health System to deliver improved and coordinated care by sharing data, clinical expertise, patient support, and an overall better consumer experience at an unprecedented level. This represents a significant step away from the traditional “fee for service” model under which providers get paid based on the volume of services they deliver. In this innovative model, Atlantic Health shares with Horizon BCBSNJ financial accountability for the health, quality of outcomes, and total cost of care for a population of patients. Newark, NJ and Morristown, NJ Septem– Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and Atlantic Health System are seeing early success in their payer-provider shared accountability program where the two organizations have agreed to tie payments for healthcare services directly to outcomes in achieving quality and cost goals. Collaborative Alignment Elevates Quality and Lowers Overall Cost by 5%
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