Horizon BCBS of New Jersey’s Secret Shopper Program Reports Savings, Care Improvements

By Jane Anderson

Horizon Blue Cross Blue Shield of New Jersey saw claims savings of $8,000 per practice per month plus improvements in several quality measures when it implemented a "secret shopper" study that evaluated the care given by its primary care providers. The Blues plan says it's the first time a large health insurer has used undercover shoppers to help physicians evaluate and improve care.

The program, funded by the Robert Wood Johnson Foundation, sent undercover actors who appeared to be real patients into practices to test the practices' customer service, provider performance, adherence to evidence-based standards, and documentation and compliance.

Visits with the mystery patients were recorded and then reviewed, along with the doctor's notes from patients' medical records, by a team of researchers. The findings then were reported back to the doctor, along with suggestions intended to help the doctor improve care.

Overall, physician behavior improved following the feedback, according to the study. A total of 45% of expected physician behaviors were observed in pre-intervention visits, while that rose to 53% of expected physician behaviors in post-intervention visits.

"The performance improvement we saw exceeded expectations," says Steven Peskin, M.D., executive medical director of population health at Horizon.

"I see this as worthwhile for a very select group of health plans — those with dominant or very high market share," says Joe Paduda, principal at Health Strategy Associates, LLC. "Otherwise, it is cost-prohibitive, as well as likely to have minimal impact on provider behavior." A payer would need to have a significant number of members using a specific individual provider for the program to make sense, Paduda says.

From Health Plan Weekly