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Horizon Blue Cross Blue Shield

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N.J. insurer, system struggle to address PR problems


Horizon Blue Cross Blue Shield of New Jersey and CarePoint Health, in Jersey City, N.J.,  are on campaigns to heal their bad PR.

CarePoint Health, a three-hospital, for-profit system, has been denounced by insurers and patient-advocacy groups for charging some of the  nation’s highest rates for out-of-network  treatment.

In defense of its out-of-network billing practices, CarePoint hired Rand Corp. to study the possible impact of pending state legislation  to limit the amount that providers can charge for out-of-network services.

The report  concluded that capping involuntary out-of-network rates to between 90 percent and 250 percent of the corresponding Medicare rate could cause between 48 percent and 75 percent of state hospitals to operate at a loss.

Meanwhile, Horizon, for its part, defended its controversial Omnia health plans,  which offer patients steep discounts for visiting providers in a preferred tier. The plans led to   lawsuits from community hospitals whose lawyers argued that the low-cost plans would force them out of business.

So Horizon announced a plan to pay for a healthcare-advocacy organization largely composed of,  and led by, business and labor groups and aimed at improving healthcare literacy among New Jerseyites.

So farm, the PR campaigns/diversions have not met with much applause.

T0 read a longer story on this, please hit this link.

Population-health coordinators in New Jersey


The Great Falls of the Passaic River, in Paterson, N.J.

Steven Peskin , M.D., of  Horizon Blue Cross Blue Shield of New Jersey, talks about population-health management, which it uses as a vital part of its  goal to lower costs and improve care.

The core of the effort is “partnering with providers to offer valuable claims information to help them better manage patients with expensive chronic conditions,” reports FierceHealthPayer.

Dr. Peskin says: “A cornerstone to our work is what we call population care coordinators. We now have more than 250 nurses across the state of New Jersey who work in the physician practices. There may be a dozen working in a large system or there might be one coordinator for two or three small practices. Although they’re employed by the actual practices, these folks are trained by Horizon. We provide a two-day training at the beginning of their tenure, so to speak, but it doesn’t stop there. It continues with face-to-face mentoring, webinars and quarterly meetings. So that’s a real lynchpin to the work that we’ve been doing with the practices.”

The care coordinators work metaphorically shoulder-to-shoulder, side-by-side with the physicians, the nurses and physicians’ assistants in the clinical practices.”

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