By Robert A. Marino
Last month marked the second anniversary of the enactment of the Affordable Care Act, the federal health reform law. Although two years have passed, health care reform is far from complete and is still very much a work in progress. There are many challenges ahead, but we are happy to report that progress is also being made.
We believe true health care reform must meet three important goals: improve the quality of patient care, begin to contain costs, and increase the number of people insured. The federal health care reform law, dealt mainly with the third goal of insuring more people. This is a positive step that will help keep more people healthy and protected from the financial consequences of illness, but much more must be done.
While the Affordable Care Act makes initial steps on quality and cost containment in Medicare and Medicaid, it falls far short in spurring the dramatic changes our nation needs to achieve these important goals for the wider population. In fact, the way we deliver health care continues to reward a greater quantity of treatments for patients, rather than the quality of that treatment. It’s no wonder health care costs continue to skyrocket.
A collaborative effort is underway that is beginning to change the way we deliver health care in New Jersey. For nearly two years now, Horizon BCBSNJ has been working with physicians, hospitals, nurses, and other health care professionals to create innovative ways of delivering and financing care.
For example, more than 80,000 Horizon BCBSNJ members are benefitting from patient-centered medical homes in 22 physician practices. Developed with the New Jersey Academy of Family Physicians and leading primary care physicians, Horizon BCBSNJ’s medical homes reward physicians for engaging their patients in their own treatment and for better coordinated, patient care that is less costly. Medical home physicians are responsible for coordinating all of the care a patient is receiving from various physicians to ensure the use of best practices and the elimination of duplicative or wasteful treatments.
In addition to medical homes, Horizon BCBSNJ is working with a number of hospitals and physicians groups to develop accountable care organizations (ACO). Like the medical homes, ACOs create accountability and financial incentives for hospitals and physicians to deliver quality care that improves patient outcomes, patient satisfaction, and contain costs. In coming months, we will announce the start of a number of ACOs that will benefit our members.
Horizon BCBSNJ has collaborated with more than 30 joint replacement surgeons across New Jersey to better manage the full scope of a patient’s hip or knee replacement surgery. Our members benefit as a result of their surgeon coordinating all of their needed care for the procedure. Again, by providing greater accountability and incentives for physicians, patients benefit from better clinical outcomes at a lower cost.
Horizon BCBSNJ is the first health insurance company to develop medical homes and innovative delivery models for joint replacement surgeries in New Jersey. While other health insurance companies are just beginning to talk about such reforms in this state, Horizon BCBSNJ is leading this effort. Our early success demonstrates how health care providers and health insurance companies can work together to transform how care is delivered.
The second anniversary of the passage of federal health care reform will generate a great deal of discussion about the benefits and challenges associated with the law. Our hope is that these discussions will lead to focus and action on quality issues and the real drivers causing health care costs to increase.
Horizon BCBSNJ members should know that we are committed to implementing all of ACA’s requirements on time and with a minimum amount of disruption. Additionally, we will continue to lead a collaborative effort to improve New Jersey’s health care system.
We appreciate our network physicians and hospitals and their commitment to these efforts. Together, we have begun an important transformation. Two years after the passage of ACA, health care reform is still a work in progress.
Robert A. Marino is Chairman & CEO of Horizon Blue Cross Blue Shield of New Jersey.