Program Details

Name of Payment Reform Program
  Accountable Care Organization (ACO)
Organization Name
  Horizon Blue Cross Blue Shield of New Jersey
Program Contact Name
  James Albano
Program Contact Title
  Vice President, Network Management and HHI
Program Contact Email
  Jim_Albano@horizonblue.com
Program Contact Phone
  973-466-8048
Program location(s)
  Only in this market
Market(s) (Ctrl-Click for multiple states)
  NJ
Lines of business
  Self-insured commercial, Fully-insured commercial, Medicare
Stage of implementation
  Full implementation (e.g. available to all intended/applicable providers and members)
Date of Implementation
  January 1, 2011
Payment reform model alignment
  Other
Other non-FSS based reform models
  FFS-based Shared-savings with quality, FFS plus pay for performance, Other: Horizon BCBSNJ has multiple arrangements in place for ACOs.
Base payment methodology
  Other
Other base payment methodology
  FFS (includes discounted fees, fixed fees, indexed fees), Other: Care coordination fees are in use.
Participating provider types
  Primary care physicians, RNs/NP and other non-physician providers, Hospital inpatient
Related outcomes for policies on non-payment for specific services associated with complications that were preventable or services that were unnecessary
  Preventable Admissions, Never Events
Performance measures used
  Achievement (relative to target or peers) of Clinical process goals (e.g., prophylactic antibiotic administration, timeliness of medication administration, testing, screenings), Achievement (relative to target or peers) of Clinical outcomes goals(e.g., readmission rate, mortality rate, A1c, cholesterol values under control), PATIENT SAFETY (e.g., Leapfrog, AHRQ, medication related safety issues), Appropriate maternity care, Longitudinal efficiency relative to target or peers, Patient experience, Utilization results, Pharmacy management
Type(s) of benefit and/or provider network design features that create member incentives or disincentives to support the payment reform program
  Financial incentives (lower premium, waived/lower co-pays) for members to use COE/higher performance providers, Use of tiered/high performance or narrow networks, Objective information (e.g., performance measure results) provided on COEs to members, providing evidence of higher-quality care rendered by these providers
Information transparency
  We report to the general public
Evaluation and results for program
  Program evaluation by insurer, Evaluation method used pre/post, Evaluation method used matched control group