Gary D. St. Hilaire is President and CEO of Horizon Blue Cross Blue Shield of New Jersey, a member of the Quality Institute’s Leadership Council. St. Hilaire joined Horizon in April.
Horizon is moving its contracting away from fee-for-service payments to alternative payment and care models. Which models do you see the most expansion in?
Horizon has been one of the value-based leaders for a decade now. And I say that as someone coming from outside of Horizon. Value-based care is about aligning resources and incentives, and working with providers to get the best outcomes for patients as well as the providers to drive down the total cost of care at the same time. By now, we have over 1.5 million members who are getting their care from providers who participate with us in a value-based program. Additionally, I think we’ve made some pretty significant strides in focusing on shared accountability models that really have two-way risk sharing as the defining feature.
In a lot of value-based programs, there’s only upside potential for providers. But when the providers working with us are taking risk for those things that they can control they’re even more engaged in the outcome. We’re trying to achieve a much better health outcome for our members at a more effective cost. We believe absolutely that the best quality care — 99.9 percent of the time — is less expensive than paying fee-for-service.
Value-based models go across all our lines of business: Medicare Advantage, Medicaid and commercial. In September, we launched Braven Health, which is a Medicare Advantage joint venture with two of our key Omnia Alliance partners, Hackensack Meridian Health and RWJBarnabas Health. The idea is again to bring that concept of shared-risk more to fruition because they now have an equity stake in how this will play out. So they share in the upside when they do well. When they do an outstanding job on the provision of care, getting to the right outcome at the better cost point, they are compensated for it. And at the end of the day, that results in a better product and a lower price.
We’ve seen the use of telehealth surge during the pandemic. How does telehealth fit into the continuum of care — and how will Horizon facilitate its use?
We see telehealth as something here to stay, and we’re excited about that. We’ve been at this for several years and I think the market has struggled to embrace it. The pandemic has obviously forced everybody’s hand. It’s a terrific way in many cases to receive care. We see a real benefit in areas like mental health — not only is it increasing access to care but members in care remain more actively engaged. And we’re seeing that members can prevent trips to urgent care or emergency care because instead they’re able to do a video call with their physician. That can significantly lower costs and get patients the outcomes they need. We’re trying from a technology standpoint to make things easier for providers and our members. Horizon is embracing a broad array of telemedicine options to ensure our members get access to the care they need. We also partner with Amwell, which is a large national telehealth platform, and Pager, which is a smaller upstart that’s done some interesting things, as well as other specialty health telehealth solutions including several focused on mental health and substance use disorders. We’re trying to connect the dots with our digital programs to give our provider partners and our members broad access to solutions that work for them.
There has been a significant increase in the demand for mental health care services brought on by the pandemic. What is Horizon doing to help increase access?
Mental health is connected to our overall health and wellbeing. We have made several changes to improve and expand access to quality mental health care.
In 2020, our mental health network grew by nearly 20 percent as a result of a concerted effort to bring more New Jersey therapists and doctors in. To augment that, we launched a number of new virtual therapy options, including those tailored specifically for people with substance use disorders, OCD, stress, anxiety — and even one with a focus helping first responders and medical professionals.
We expanded access to telehealth and worked with our network providers to help them quickly pivot from in-person care to virtual care at the onset of the pandemic. And to help make sure that cost was not a barrier to mental health care, we made significant changes during the public health emergency to co-pays, deductible, and co-insurance.
We’ve continued to cement our commitment to the integration of physical health and behavioral health, partnering with our primary care network to give them more tools to screen, treat and, when needed, quickly refer members into our behavioral health network. We also expanded a specialized program for members with severe or chronic mental health conditions. We call it our Integrated System of Care. It relies on local mental health partners to quarterback care and address physical health, social needs, and mental and substance use services.
We know that things like diabetes or heart conditions often impact mental health so we’re focused on assuring that mental health is a consideration in all of our case management and chronic disease management programs.
The number of Medicaid beneficiaries in New Jersey is now over 1.9 million, and Horizon manages and pays for more than 50 percent of that market. What can health plans do to control the public cost of this program while continuing to ensure access to quality health care for our most vulnerable residents?
So, for instance, we were talking about our value-based programs — our investments in telehealth and with mental health. Those apply to this market as well. Early this year, we launched Horizon Neighbors in Health, which is a comprehensive social determinants of health program. We’ve done some work with RWJBarnabas on this initiative. If members have a challenge with food security, or housing, it will impact their health and wellbeing. This model uses community health workers and personal health assistants to address these critical social elements that currently fall outside the traditional care delivery model, such as employment, education, physical environment, and social supports. We provide these high touch, personalized programs to address social determinants of health.
We like to ask a question that’s not about work and policy. So where can we see you on a sunny weekend day when you are not working?
Well, one of my passions is family. I have six children and we’re expecting our second grandchild. I also enjoy the outdoors, spending time whether it’s on a trail walk or just taking a stroll around a lake. I enjoy nature. And we’ve done a lot of that with our kids over the years.