Horizon Blue Cross Blue Shield of New Jersey and Barnabas Health are launching a new accountable-care organization this fall to deliver better-coordinated medical care to Horizon's Medicare Advantage members, who are Medicare members who receive that program via Horizon's network.
Barnabas Health will serve Horizon Medicare Advantage patients through its two existing Medicare ACOs. The northern ACO includes three Barnabas hospitals — Newark Beth Israel, St. Barnabas Medical Center and Clara Maass Medical Center — about 10,000 Medicare patients, and about 400 doctors. The other ACO in Central Jersey has three Barnabas hospitals — Monmouth Medical Center, Community Medical Center and Kimball Medical Center — joint venture partner CentraState Medical Center, about 20,000 Medicare patients and about 200 doctors.
Medicare ACOs have been launched across New Jersey over the past year or so to enable health care providers to share in the money the federal government saves through a more efficient delivery of Medicare. ACOs seek measured improvement in patient quality outcomes, and to save money through a decrease in unnecessary and duplicative medical tests and treatments.
"Our collaborative ACO program highlights our mutual desire to transform the health care delivery system in New Jersey by providing support to improve care coordination and positive patient outcomes," said Jim Albano, vice president of network management and Horizon Healthcare Innovations.
"As we enter a new age of health care, in which we will be responsible for managing populations of patients, the relationships we establish must share our values of improving the quality, access and efficiency of the care we deliver," said Anthony Slonim, chief medical officer of Barnabas Health.
Slonim said Horizon Medicare Advantage ACO differs in some ways from the existing Medicare ACO.
He said Horizon will make upfront incentive payments to doctors "to help engage physicians, in terms of improving quality measures, efficiency measures and patient satisfaction." If savings are achieved, they will be shared between Horizon, the ACO and the doctors. Under the existing Medicare ACO, there are shared savings, but no upfront payments.
Slonim said making approprate use of emergency room care is one aspect of the work that goes on in an ACO.
"If we have an overutilization of ER services, we want to talk to our doctors about ways to improve this," he said. That can involve having physicans provide more flexible hours, so that patients see their own doctors instead of using the ER.
In recent years, Horizon has launched a number of patient-centered programs, including ACOs and patient-centered medical homes, and said today more than 320,000 of its members and 1,400 doctors are participating in these programs.
Reporter Beth Fitzgerald is @BethFitzgerald8 on Twitter.