The Customer

Horizon Blue Cross Blue Shield of New Jersey (Horizon) is a major insurer covering half of New Jersey’s commercial market and serving 3.7 million members, including a fully-owned Medic- aid subsidiary. Reflecting Horizon’s deep commitment to healthcare industry transformation, more than two million members receive care in value-based settings. Most of those participate in four key value programs across the spectrum of acute, primary and specialty care

  • 7 Strategic Alliance Partners
  • 200+ Patient Centered Medical Homes
  • 19 ACOs
  • 100+ Episodes of Care programs

These programs currently operate in a variety of reimbursement models, including shared savings, shared risk, fixed fee, case rate, and other models.

Strategic Objectives and Directions

A chief strategic aim for Horizon is “to bring a fully integrated delivery approach to a currently unintegrated environment,” said Joe O’Hara, Director, Healthcare Marketplace Innovations. Despite consolidation that has produced three large health systems in New Jersey, the level of data availability and exchange needed to optimize value is still lacking. Horizon is driving “virtual integration” through a combination of technology, process, and incentives. Horizon’s goals include creation of a comprehensive medical record and employing analytics against rich data sets to identify highly focused population cohorts and help create consistent, individual care plans. Horizon believes its uniquely positioned to realize this vision since, as O’Hara notes, “Insurers know a lot of valuable information about patients and maintain ongoing relationships beyond care events.”