Horizon BCBSNJ, Meridian Health sign collaborative ACO agreement

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) and Meridian Health announced a collaborative Accountable Care Organization (ACO) agreement for its new OMNIA health plan members through Meridian Health Partners, Meridian's clinically integrated network. Horizon BCBSNJ members who enroll in an OMNIA plan would enjoy lower premiums, and if their care is delivered by the ACO's doctors and ancillary providers -- which are Tier 1 for OMNIA health plan members - they will also save on out of pocket costs. The ACO includes doctors who are part of Meridian Health Partners, doctors at Meridian hospitals, and affiliated ancillary providers and independent physicians throughout Monmouth and Ocean counties.

"This patient-centered ACO with Meridian Health is in keeping with Horizon's efforts to transform New Jersey's health care system, with a focus on delivering better patient care, an enhanced patient experience, and lower total costs," said Allen Karp, senior vice president of Healthcare Management for Horizon BCBSNJ.

"The health and well-being of our community has always been our number one priority," says Patrick Young, executive vice president of Meridian Health Solutions. "As we continue to focus on affordable, high-quality health care, our collaboration with Horizon and this ACO agreement, through Meridian Health Partners, will allow us to promote better clinical integration and patient experience for its OMNIA health plan members."
ACOs are built on a primary care foundation with an emphasis on preventive care that keeps patients well. Participating physician groups help create a healthier patient population through a coordinated and more active approach to patient care among providers within the ACO. ACOs are designed to increase accountability to achieve improved quality outcomes for patients and decrease unnecessary and duplicative medical tests and treatments.

Under the ACO agreement with Meridian Health Partners, Horizon BCBSNJ will provide care coordination payments to Meridian Health Partners to take on additional accountability for its OMNIA health plan members by improving the health and patient experience as well as controlling the total cost of care. Meridian Health Partners and its physicians will have an opportunity to share in the resulting financial savings with Horizon BCBSNJ, provided they meet certain clinical quality, patient satisfaction, and cost savings measures.

Patient-centered practices, including ACO's, provide patients with more coordinated and personalized care, including:

•A care coordinator who provides additional patient support, information and outreach.
•Wellness and preventive care based on national clinical guidelines.
•Extra wellness support and education.
•Active patient monitoring and communication from the doctor and care coordinator.
•Active coordination of a patient's care with specialists and other providers.

There are more than 6,000 network doctors and greater than 750,000 members participating in in Horizon BCBSNJ's patient-centered programs. The patient-centered practices include doctors in Patient-Centered Medical Homes (PCMHs), ACOs and practices focused on Episodes of Care across New Jersey.

For 2016, the majority of the providers participating in Horizon BCBSNJ patient-centered programs, such as Patient Center Medical Homes and ACOs, including this collaborative with Meridian Health and the physicians of Meridian Health Partners, are designated as OMNIA Tier 1 under the new OMNIA health plans. The OMNIA health plans are being offered to employers and individual consumers beginning January 1, 2016.

Source: Meridian Health