Mary Ann Christopher is Chief of Clinical Operations and Transformation at Horizon Blue Cross Blue Shield of New Jersey. She joined us for a Take Five.
How do you describe Value-Based Care?
The tenets of Value-Based Care create the underpinnings of the Triple Aim. We heard the call by the Institute for Healthcare (IHI) Improvement six years ago and have worked to focus our strategies on providing access to health care in ways that are most meaningful and convenient for people. We have focused in renewed ways on the critical importance of the health care journey and the patient’s overall health status. And we are ever mindful of the cost parameters and the fact that we all pay for health care — either as taxpayers or through our work. We have a commitment to make sure that every member’s journey is optimized to the tenets of the Triple Aim, and we have an understanding of how each individual’s journey informs the greater public health of our state.
How can an insurer integrate the goals of population health into its consumer products?
At Horizon, we take a consumer-centric approach. The voice of the consumer is heard in the way we design our benefits and in the programs and collaborations we establish with our providers and communities. In the past six years we have been putting in place many programs that enhance the opportunity for consumer engagement in patient-centered medical homes. We engaged in a relationship using nurses as care coordinators and transformational coaches. I was invited to be part of the Horizon BCBSNJ collaboration involving the Schools of Nursing at Rutgers University and Duke University. The collaboration educated nurses to serve as transformational coaches in primary care practices throughout New Jersey.
We are supporting models of care that engage the social service infrastructure that supports consumers where they live, worship, work and go to school. Our transformational models engage non-traditional providers — maybe in senior centers, or through maternal child wellness programs. We get involved in what people might think is outside the traditional areas of health but that are frankly critical to how people get care and maintain levels of wellness.
You are a nurse who worked as CEO of the Visiting Nurse Association Health Group. How does your background in nursing inform your work as an executive today?
A core competency of nursing is that I have been enculturated in the holistic approach. The nursing discipline is based on respect for and an understanding of the multi-factorial aspects of health: physical, emotional, social, environmental and spiritual. When we think. ‘What does Value-Based Care mean?’ we are called to be sensitive to the patient experience. Nurses have a critical understanding of how the socio-demographic variables influence health and health care. It’s about health literacy, housing, education, social isolation, cognitive functioning, and mental health. With backgrounds that emanate from an appreciation for this holistic construct, nurses are positioned to make major contributions to value-based transformation. Nurses are exquisitely sensitive to the value of interprofessional collaboration. For me, the time I worked in homeless shelters and boarding homes, and with faith-based coalitions, prepares me to bring an important perspective to the care of fragile populations and allows me to contribute in ways that are important to Horizon.
Many physicians are feeling the pressure of payment reform and argue they are being asked to take on too much risk. How can an insurer get physicians on board with the changes ahead in health care?
Six years ago Horizon made the decision to support the journey in primary care from fee-for-service to value-based care. We are moving incrementally and respect that providers have one foot in two very different worlds right now. We provide value-based metrics that support primary care practices in delivering value driven, patient-centered care coordination. We have taken the very important step of educating, supporting and mentoring nurses embedded in interprofessional primary care practices. We have one of the largest and fastest growing Episodes of Care programs in the country. It allows the physician to be reimbursed as fee-for-service yet creates incentives for the achievement of value-based parameters for individual patients and the larger population. We are taking steps. This is not a flick of a switch. We appreciate that this is a journey for doctors, nurses, health systems and for all of us. We are listening. When the primary care community said we needed to think about how to integrate behavioral health into primary care we listened. We are now developing a pilot that will integrate funding support for behavioral health integration and treatment. This is one example of how we will evolve and enhance value-based health care transformation.
When you envision the future of health insurance do you see refinement of emerging models — tiered networks, value-based care — or something completely different?
The future will certainly be in value-based relationships. We believe and others do as well in an integrated delivery system. The lines between the sector and silos will continue to blur to create greater meaning for patients and for the broader population. We believe the handoffs across the continuum are critical. So often patients fall through the cracks because practitioners are rendering care in silos. The movement to create a culture of health — being ignited by many, the Robert Wood Johnson Foundation being one — is a core value in the transformation of health care. Our commitment at Horizon is to be involved in the dialogue in a grassroots way and give consumers meaningful ways to be part of the conversation. We also have a tremendous amount of data to help us understand a community down to the neighborhood level. This is a very exciting time.