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Horizon Health Sphere, an answer to UHC's Optum, appeals to younger generation of docs

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Horizon Blue Cross Blue Shield of New Jersey is developing its own answer to United Healthcare’s Optum, which was independently developed in 1995, called Horizon Health Sphere, NJBIZ has learned.

Health insurers are increasing their footprint in the data and analytics business, providing health information exchanges as cost control tools, as well as potentially new streams of revenue.

Horizon Health Sphere applied for a trademark in January and has not been formally rolled out yet.

Allen Karp, senior vice president of health care management at Horizon, said the state’s largest insurer is working with health systems to compile data that will help in delivering better care, as well as provide greater cost predictability for the insurer.

“(Health providers) think they have the full picture of the patient, but they don’t,” Karp said. “Because they don’t really get pharmacy costs, they don’t get out-of-network costs. I mean, you would be surprised when you talk, even when their own physicians in their ACO (accountable care organization) or CIN (clinically integrated network), they don’t know where they are referring (patients to).”

Some of the highest health care costs come from interacting with out-of-network providers — a debate which has been ongoing in Trenton for eight years.

Sometimes it occurs during a procedure where a specialist who is out of network is suddenly required to interact with a patient, other times it happens when providers have relationships with other facilities, such as labs, without realizing they are sending a patient out of network.

“So, what we will do is open medical records and combine that information, and provide actionable information for both health system and provider. There is no real database for them to work off of,” Karp said.

The idea is one that may appeal to the younger generation of doctors entering the medical field.

“If you talk to older physicians, they say it’s more of an art than science,” but the younger generation coming out of school feels differently, Karp said.

On the flip side, to help patients, Horizon is partnering with an undisclosed third party to pilot an app for the patients themselves to have more control over costs.

The Open Table-like app, similar to ZocDoc but “on steroids,” will allow a patient to schedule appointments and look up providers that are in network.

Both programs are top of the list for Horizon this year, Karp said.

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