Data Sharing, Teamwork Essential to Pediatric Value-Based Care

Cooperation with providers and data sharing are key to success in pediatric value-based care, Horizon Blue Cross Blue Shield New Jersey (BCBSNJ)’s 2018 care quality results show.

“Horizon and our provider partners are able to achieve better outcomes together because we freely exchange knowledge and expertise, and we share claims data and resources that help doctors better understand their patients and our members,” Allen Karp, Horizon BCBSNJ’s executive vice president for healthcare management and transformation, said in the press release. 

“We also all believe that by working together as a team, versus separately in silos, we have the best chance at delivering better care, a better patient experience and lowering costs for the patients we serve.”

In 2018, the payer invested over 60 percent of its medical care spending, or $100.8 million, in value-based arrangements.

Specifically, the payer engaged in shared savings payments, where providers form accountable care organizations (ACOs) that are willing to take on financial risk based on patient outcomes. These arrangements are thought to cut costs and improve outcomes.

Horizon BCBSNJ says it saw an improvement in one year alone due to these measures.

In its value-based pediatric program, the payer increased immunizations by 11 percent. It saw a 21 percent rise in child well visits as well as a nine percent increase in weight counseling and monitoring visits. Moreover, the company’s immunizations of two-year-olds were seven percent above the national average and 14 percent above the national average for adolescents.

These statistics are critical as experts say that applying holistic, value-based care to pediatric practices can influence future generations to adopt healthier practices and a value-based care mindset. The success of value-based pediatrics such as Horizon BCBSNJ's can help foreshadow that impact.

But Horizon BCBSNJ’s results were not isolated to adolescents alone. 

Due to the focus on value-based care, the payer saw better results in preventive care screenings for women. The company saw six percent more breast cancer screenings and four percent more cervical cancer screenings in its value-based care settings than its non-value-based care partnerships. 

Such screenings are pivotal to saving lives and cutting costs. The Society of Breast Imaging says that in the past thirty years since the introduction of the mammogram, breast cancer death rates—which had been stable for decades prior to the mammogram—fell by more than 30 percent.

“Therapy has improved,” the society states, “but lives are saved when breast cancers are detected and treated earlier.”

In both adult and pediatric care, Horizon BCBSNJ aims to keep preventive care at the center of its value-based care strategy.

“Wellness and preventive care are hallmarks of the patient-centered approach,” Don Liss, MD, vice president and chief medical officer for Horizon BCBSNJ, said. “Whether we’re working with a pediatric practice to help ensure that children are immunized, or working with other specialists and hospitals to coordinate the care necessary to keep all our members well, Horizon and our patient-centered providers understand the power of preventive medicine.”

Preventive screenings are essential to that, but community intervention, community activation, and data and technology all play significant roles as well.

The latter of those options is one that a provider who works with Horizon BCBSNJ particularly emphasized.

“Horizon’s Value-Based program enables a large organization like BCD Health Partners to easily collaborate, share data, maintain a high clinical quality standard for our patients and achieve our goals,” said Jill Stoller, MD, FAAP, president and chief executive officer of BCD Health Partners LLC, a participant in Horizon BCBSNJ’s pediatric value-based program. 

“The well-defined clinical information we receive through our partnership with Horizon allows us to regularly review our performance and understand how we can achieve and outperform the quality outcome objectives we set for our patients. We see even greater potential for improving patient care quality as Electronic Medical Records capabilities improve and the data we share with Horizon becomes even more defined and precise.”

Payers are increasingly taking note of how data and the movement of data are key components in value-based care. In a fireside chat at Xtelligent Healthcare Media’s Value-Based Care Summit, Larry Blosser, MD, outpatient medical director at Central Ohio Primary Care Physicians, echoed Stoller’s remarks and added that payers must parse the data for providers or providers must learn how to make the data actionable.

“We, as a group, have just always said, ‘we want data, we want data, we want data,’ and then all of a sudden you get somebody who gives you data. Now you're like, ‘what am I going to do with this?’” Blosser explained. “It is really important to be able to understand the data you're getting. I don't think any of us, as physicians, were ready to do that. I think we had to add that capability, ultimately.”

The results of Horizon BCBSNJ’s value-based care program underscores what many see as the critical arguments in favor of a value-based system—namely, better patient outcomes—and the increasingly recognizable paths to achieving success through patient-centered payer-provider partnerships and data sharing.