Horizon BCBSNJ invests in tech for better provider relations, patient care

As health insurance becomes more retail-based and consumer-oriented, insurers need the right technology to adapt to the ever-evolving environment.

To keep up with changes in the insurance marketplace, Horizon Blue Cross Blue Shield of New Jersey directed much of its technology innovation dollars toward preparing for healthcare reform and the health exchanges.

Now that reform implementation is well under way, the insurer is focusing its technology resources on developing new relationships with providers, such as patient-centered medical homes and accountable care organizations, Horizon BCBSNJ CIO Doug Blackwell told FierceHealthPayer in an exclusive interview.

"We see a much stronger alignment between both the provider world and the payer world and [information technology] is going to be a big piece of that," he said.

Data exchange plays a key role in making those new provider relations work, said Blackwell, who pointed to health information exchanges that share clinical and claims data among the different entities to improve cost management and overall patient care.

"It's really what enables and provides capabilities to support those new value-based models," Blackwell told FierceHealthPayer.

Similarly, sharing data is what makes Aetna's ACOs work. The insurer gives its provider partners unprecedented access to data, empowering them to deliver higher quality care at a lower cost, Charles Kennedy, CEO of Aetna's accountable care solutions, told FierceHealthPayer in a previous interview.

Horizon BCBSNJ also uses technology to enhance provider and member experiences. For instance, it has a portal interface to provide physician practices and hospitals eligibility and benefit information as well as claims and payment status. And for members, the insurer has added ecommerce capabilities for private and off-exchange business and mobile application upgrades, Blackwell noted.

It's also enhancing its own technology infrastructure with, for example, a master data management program to provide high-quality data that can implement applications faster and cheaper and more consistently. Horizon BCBSNJ also is investing in various data analytics tools that allow the insurer to determine target areas where it can improve care.

Recognizing that health insurers must adapt to the industry's "cataclysmic change" or be out of business in 10 years, Minnesota-based Medica has put investment dollars toward innovative technology, FierceHealthPayer previously reported. With new technology tools, Medica has created a new health plan model with more flexibility and automation, doing more processes with fewer resources and providing better service to members.