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Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has awarded $3 million to 51 specialty medical practices as part of a shared savings arrangement through the company's Episodes of Care (EOC) program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members.
As the largest commercial payor of Episodes of Care in the United States, Horizon BCBSNJ recently reported far lower hospital readmission rates and improved clinical outcomes for members in its EOC practices versus non-EOC practices in 2014:
- 100 percent fewer hospital readmissions for Knee Arthroscopy;
- 37 percent fewer hospital readmissions for Hip Replacement;
- 22 percent fewer hospital readmissions for Knee Replacement; and
- 32 percent reduction in unnecessary Pregnancy C-Sections.
During Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, a March 31, 2016 webinar, now available for replay, Lili Brillstein, director of the Horizon EOC program, shares the details behind the health plan's EOC program, from the episodes they have bundled to the goals and results from the program.
You will learn:
- Why Horizon BCBSNJ uses a retrospective, upside-only model for its EOC program and how this is leading to a transformational change between the payor and the providers in its network;
- How Horizon BCBSNJ determines which episodes, as well as which providers to include in the EOC program, including details on how smaller practices can form virtual groups to gain enough scale to participate and which episodes are high on the radar for EOC in 2016;
- The goals of the EOC program and which key financial, quality and patient satisfaction indicators Horizon BCBNJ measures; and
- The results to date from the EOC program as well as the keys to the program's success.
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You can attend this program right in your office and enjoy significant savings ó no travel time or hassle; no hotel expenses. It's so convenient! Invite your staff members to gather around a conference table to listen to the conference.
WHO WILL BENEFIT FROM THIS CONFERENCE?
Presidents/CEOs/CFOs, medical directors, quality improvement executives, physician executives, health plan executives and strategic planning directors and consultants.
ABOUT OUR PANELIST:
Lili Brillstein is the director of episodes of care for the market innovations division of Horizon Blue Cross Blue Shield of New Jersey. She is responsible for the overall direction, strategy, design and oversight of the Episodes of Care/Bundled Payment Program.
When Ms. Brillstein joined Horizon in January 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. Under her leadership, the program has grown to include additional orthopaedic episodes, obstetrics and gynecology, GI, cardiology, oncology, and is the largest commercial Episodes program in the country. She also plays a leadership role in the advancement of Horizon's PCMH, ACO and other value-based models.
Ms. Brillstein serves as an advisor to CMS and other organizations, nationally, on episodes of care and bundled payment development, and is a recognized thought leader in the advancement of the Episodes of Care model as a healthcare value strategy for specialty care.