The purpose of the OMNIA Alliance, a relationship Horizon Blue Cross Blue Shield of New Jersey launched three years ago with six hospital systems and the state’s largest physician network, has finally been revealed.
Kevin Conlin, in his first interview since becoming the CEO of Horizon in January, detailed some of the relationships Horizon has created with its Alliance partners and how some of them are faring.
Conlin said the Alliance is giving Horizon an opportunity to redefine its role in the overall health care system.
“We are evaluating what should be our role in being more aggressive with regard to providing some financial support for social determinants of health,” he told ROI-NJ. “Part of what we are looking at is, in the commercial sector, what is the right thing to be doing?”
“If we can help address some of what is driving the poor health status further upstream — usually at pennies on the dollar — the savings you are going to have is going to be significant, the improvement you are going to have in health status is significant and the savings we’re going to have in total cost over time is going to be significant.”
One example of this is a broader project with RWJBarnabas Health, which has been focusing on social determinants of health in Newark.
Following a similar analysis used by the Camden Coalition, RWJBH and Horizon identified four ZIP codes where the costliest or most frequent patients lived.
About 1,000 patients were identified in the ZIP codes, Conlin said.
Horizon then hired a team to address the issue.
In April 2017, Horizon and RWJBH formed a team that includes a Horizon care transformation specialist, personal health assistant, health system-based social worker and community health workers recruited from the neighborhoods they served.
The team investigated the causes for the patients’ poor health and utilized resources and funding to address them.
The funding from Horizon and RWJBH went toward assisting members to obtain a mortgage loan to afford medical expenses, providing behavioral and social support to a suicidal patient, and building an in-home care platform, including medical education from a registered nurse to help a stroke patient live independently.
To-date, the program has reduced total cost of care by 25 percent, reduced inpatient admits by 20 percent, reduced ER visits by 24 percent, reduced specialty visits by 25 percent and increased behavioral health visits by 35 percent, according to Conlin.
“The results we’ve gotten are significant,” he said.
In fact, it has inspired Conlin to look at expanding the efforts to other providers in the state.
Conlin said it represents why the Alliance was created.
All of the partners are tasked with figuring out exactly what metrics will define value-based care and how to realistically hold all parties accountable, Conlin said.
That applies to all the partners: AtlantiCare, Atlantic Health System, Hackensack Meridian Health, Hunterdon Healthcare, Inspira Health Network, RWJBarnabas Health and Summit Medical Group.
“We are also committed to the concept that measurement and reporting of quality should be a by-product of the actual delivery of care, and not a time- and resource-consuming exercise, so that maximal effort on actual improvement of the performance is made,” he said.
Another relationship focuses on broader-based projects to treat vulnerable populations.
With Inspira Health Network, that includes a partnership on behavioral health.
Inspira’s primary care practices were struggling to meet the level of behavioral and mental health care that was necessary for its provider population, Conlin said.
“They serve a more rural marketplace than the average in New Jersey,” Conlin said. “When we were talking with them, we identified together there was, frankly, a manpower issue with behavioral health professionals to support their primary care professionals.”
Horizon brought in Quartet, which it has an ownership stake in, and used its telehealth platform to help Inspira reach more patients.
To date, 89 primary care doctors at 31 Inspira-owned or -affiliated primary practices have registered, of which 57 doctors are receiving referrals. Conlin said the new platform has helped 583 patients since the partnership launched in January.
The relationship, however, is not exclusive to Inspira and Quartet. Conlin said it is available as a partner for all in-network behavioral health care providers.
Across the state, 725 primary care physicians and 518 behavioral health providers have signed up, and about 3,000 Horizon members and more than 1,200 nonmembers have used Quartet to be seen by a behavioral health care provider.
“The thing that I’m most pleased about is we have gotten real traction with regard to the goal of working more collaboratively with our partners,” Conlin said. “That signals that the experiment of collaboration between an insurer and a provider is truly working.”