Horizon Blue Cross Blue Shield of New Jersey announced Dec. 31 to New Jersey’s skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) providers that naviHealth will be a delegated partner in the management of post-acute SNF and IRF benefits, effective Feb. 1.
This change affects Horizon’s Medicare Advantage plans, as well as its new dual-eligible special needs plan, Horizon NJ TotalCare.
Beginning Feb. 1, prior authorization must be obtained from naviHealth for admission and concurrent stay in a skilled nursing or inpatient rehabilitation facility. Skilled nursing facilities in Horizon’s Medicare Advantage and D-SNP networks are asked to respond to an online survey that seeks information on their capabilities to manage different conditions including bariatrics, wound care, tube feeding, intravenous care, ventilator weaning, dialysis and chemotherapy.
naviHealth has partnered with many of the Blues plans across the nation to manage post-acute care services. According to the Horizon announcement, naviHealth care coordinators collaborate with patients, caregivers and facility care managers to provide care transition planning and clinical review authorizations of post-acute care services, with the primary goal of supporting a patient through recovery in the most appropriate, least restrictive setting.
However, the rollout of this partnership in other states was, at least initially, met with pushback from post-acute care providers and associations who alleged that naviHealth’s approach was simply to reduce cost by cutting post-acute care length of stay, based on the company’s analytics capability without enough emphasis on the individual circumstances of a patient. In addition, other states are seeing health plans that are partnered with naviHealth using the data as a tool to narrow their Medicare Advantage and D-SNP networks.
Horizon will be offering providers opportunities for education about this partnership in early January. NJHA will be working closely with Horizon and members to help achieve a smooth transition.
