Balancing care and cost: Innovating solutions for affordable health care in N.J.

The state of New Jersey consistently achieves top rankings for its health care facilities and patient safety, but the top-tier care comes at a cost: New Jersey ranks at the bottom half of states for health care affordability. It’s estimated that nearly 10% of residents who needed to see a doctor in the past year didn’t go because they couldn’t afford it. This statistic underscores the urgent need for insurance companies, health care providers and policymakers to collaborate on innovative solutions that ensure greater access to affordable care for everyone in need.

Dennis Bone. (Courtesy photos)

Through Move Health Care Forward NJ, we are advocating for ways our state can meet consumers’ expectations of convenient, affordable and quality health care. It’s especially important, in this post-pandemic landscape, to prioritize the implementation of innovative approaches that enhance accessibility, while maintaining high standards for both physical and behavioral health care. Insurers can play a leading role in advancing patient-centric care in three key ways:

  • Forging cross-industry partnerships;
  • Developing consumer-friendly technology;
  • Expanding preventative care programs.
Steve Sweeney.

Here’s how we can do it.

  • Working together: Providing affordable access to care is a team sport, and it requires progressive collaboration. Among the most successful examples of this are the long-term partnerships between insurers and health care systems. In 2020, Horizon Blue Cross Blue Shield of New Jersey joined with Hackensack Meridian Health and RWJBarnabas Health to create a unique Medicare Advantage Plan called Braven Health. Braven Health was New Jersey’s first payer-provider-owned Medicare plan. Its plans offer lower cost coverage, including $0 premiums, low out-of-pocket costs and flexible out-of-network coverage. By partnering with New Jersey’s leading health care systems, Braven Health is able to give patients in-network access to thousands of physicians to deliver high-quality, personalized care. Insurance companies such as Cigna, Aetna and AmeriHealth also are collaborating with health systems and their physicians to provide greater access to value-based care. Cigna is rewarding providers for improving quality, affordability and patient experience, and it’s taking an active role in coordinating patient care. Aetna offers a range of incentives for companies and health systems to join its partner programs, which gives its subscribers access to discounted fitness services, access to second opinions and other services that can contribute to overall wellness.
  • New technology: The use of technology in health care is expanding rapidly, and insurance companies are staying ahead of the curve by adopting digital tools that make it easier for their subscribers to get the care they need. Insurers are offering free or low-cost telemedicine and virtual behavioral health visits, 24/7 access to nurse lines, and portals and apps that allow patients greater control of their care. Many companies are offering patient cost estimator tools to help their subscribers understand how much they’ll pay out of pocket for services. Others offer a tool that aggregates patients’ test results, diagnoses and medications and allows users to set goals and follow digital wellness programs. Most modern insurance portals also allow patients to check on the status of their claims and view covered services, instead of waiting for their Explanation of Benefits to arrive in the mail.
  • Expanding preventative care programs: Insurance companies are embracing preventive medicine, offering a multitude of preventative care options to proactively improve the health and quality of life of their subscribers. While the Affordable Care Act requires most private insurers to offer a suite of preventative care services at no cost to subscribers, many insurance companies have gone beyond what is legally required. Those services include immunizations, depression screenings, alcohol misuse counseling, cholesterol screenings and many other wellness benefits.

Several New Jersey health systems, including Hackensack Meridian Health, are part of a statewide initiative to expand behavioral health screenings during annual pediatric visits. Insurers including Aetna and Horizon also offer condition management programs that give their subscribers additional tools and resources to help manage chronic illnesses or injuries. Patient compliance and early intervention can significantly improve the trajectory of chronic illnesses, further underscoring the importance of the management tools offered by insurance companies.

Health care has faced unprecedented disruptions throughout the COVID-19 pandemic, but industry stakeholders now have the ability to make meaningful change for our state’s most vulnerable populations. We are at a critical moment, and we are urging insurers and providers to work together to safeguard New Jersey’s position as a national leader for health care. As the co-chairs of Move Health Care Forward NJ, we implore swift collaboration between leaders of our esteemed health care organizations. Together, we can ensure every individual, regardless of their financial circumstance, has access to quality care.

Dennis Bone (the former CEO of Verizon) and Steve Sweeney (the former state Senate president) are co-chairs of Move Health Care Forward NJ.