Navigation Links
Results Show that Doctors, Patients and Horizon BCBSNJ Members All Win from Company’s Innovative “Episodes of Care” Program

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced today that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative 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.

The EOC model is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event -- such as a joint replacement or pregnancy. The physicians and Horizon BCBSNJ define the episode components and determine the quality of care outcomes. It’s a collaboration from which physicians are able to determine best approaches to care delivery while reducing costs and enhancing the medical experience for the patient – also known as the “triple aim.” When they achieve the triple aim, Horizon BCBSNJ rewards the doctors with shared savings, on top of their fee-for-service reimbursement.

“For the last six years, Horizon has been collaborating with doctors and hospitals across the state to change the way health care is delivered and financed in New Jersey,” said Allen Karp, senior vice president of Healthcare Management for Horizon BCBSNJ. “The results of our EOC program show how we can work together to make New Jersey’s health care system more coordinated and cost-efficient while raising the bar on quality.”

Horizon BCBSNJ received results from the following five episodes for 2014:

  •     Hip Replacement
  •     Knee Replacement
  •     Knee Arthroscopy
  •     Pregnancy
  •     Colonoscopy

For its 2014 results, Horizon BCBSNJ reviewed claims data for members receiving care from an EOC practice and those receiving the same procedure from a non-EOC practice. Horizon BCBSNJ members in EOC practices had a far lower hospital re-admission rate and experienced other high quality outcomes compared to members receiving the same services from a non-EOC practice:

  •     100% fewer hospital re-admissions for Knee Arthroscopy.
  •     37% fewer hospital re-admissions for Hip Replacement.
  •     22% fewer hospital re-admissions for Knee Replacement.
  •     32% reduction in unnecessary Pregnancy C-Sections.

“These results demonstrate how Horizon and its providers are working collaboratively to move from a fee-based reimbursement system to one that improves the quality of care, enhances patient satisfaction and reduces costs.” said Lili Brillstein, director of Horizon EOC program. “Rewarding doctors for quality, while wringing excessive, duplicative costs out of the delivery system, is at the core of value-based care,” she added. The company continues to add more episodes to its program, which now includes congestive heart failure, hysterectomy, lung cancer, breast cancer and colon cancer.

“The Episode of Care model is a game changer in the progress from fee for service to value based contracting,” said Charles A. Accurso, MD, a Hillsboro gastroenterologist in Horizon BCBSNJ’s Colonoscopy EOC. “By tying financial incentives to quality, it improves the care of the patient while also decreasing costs,” he said.

“Horizon’s EOC program has become one of the fastest growing and most progressive commercial bundled payment programs in the country,” said Amita Rastogi, MD, Chief Medical Officer, HCI3 (Health Care Incentives Improvement Institute, Inc.

As of the close of 2015, more than 800,000 Horizon BCBSNJ members were part of the company’s value-based programs, such as Episodes of Care, Accountable Care Organizations and Patient-Centered Medical Homes.

About Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey, the state's oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.8 million members.


Read the full story at

Source: PRWeb
Copyright©2016 Vocus, Inc.
All rights reserved

Related medicine news :

1. Chronic Care Management Company Releases Early CCM Program Results
2. February HydroWorx Webinars Discuss Aquatic Therapy Protocols, Results and Profitability
3. AxoGen, Inc. to Report Fourth Quarter and Full Year Results on February 29, 2016
4. Today’s Best Cosmetic Surgery Review Site, Featured One of Newport Beach Facial Plastic Surgeon’s Incredibly Natural-looking Facelift Results
5. Watertree Health Reports Year-End 2015 Social Responsibility Results
6. McGaw YMCA's Y Readers Reached More Students; Boosted Test Results Even Higher
7. Top 5 Patient Safety Accomplishments: Physician-Patient Alliance for Health & Safety Recognizes Key 2015 Patient Safety Results
8. xR’s Emerging New Therapy to Treat Wet Macular Degeneration Non-Invasively Showing Unprecedented Results
9. Nashville Dermatologist Predicts Less Downtime, Quicker Results for Cosmetic Procedures and Products in 2016
10. MADD and Nationwide Announce New Survey Results Showing Rise In The Use of Designated Drivers
11. METTLER TOLEDO’s New Lab Portal Means Better Lab Results Are One Click Away
Post Your Comments:
(Date:9/17/2019)... , ... September 17, 2019 , ... ... is pleased to announce the release of the third edition of The Gift ... easy-to-read guide for patients, caregivers and families to navigate the clinical research process. ...
(Date:9/17/2019)... ... September 17, 2019 , ... ... Open House day on Pacifica's Lambert Campus, 249 Lambert Road, Carpinteria, CA. ... the Humanities, Clinical Psychology, Counseling Psychology, and Mythological Studies. Program Faculty will ...
(Date:9/14/2019)... ... ... GreenTheVoteOk , one of the most reliable online resource providers on ... relevant and important developments in the fast-changing world of legalized CBD. , With ... the world suffering from different difficult-to-treat ailments, people need to identify brands that offer ...
(Date:9/11/2019)... ... 2019 , ... “Heart Seizures”: a useful source of knowledge that tells about ... to prevent anyone from having it and to help those who are suffering with ... was diagnosed with coronary artery disease. Predicted to experience another probable heart attack six ...
(Date:9/11/2019)... ... , ... A September 2 article on CBS News details a ... likely to suffer heart attacks, strokes, kidney failure, and heart disease versus a control ... surgery specialists Dr. Feiz and Associates says the study adds further evidence to an ...
Breaking Medicine News(10 mins):
(Date:9/17/2019)... ... September 17, 2019 , ... For the 6th year in a row, Mental ... ranks all 50 states and the District of Columbia based on several mental health and ... The report also takes a look back on the trends of the last 6 years ...
(Date:9/17/2019)... ... ... Drs. Nickelice Brand and Chris Williams restore smiles of Ocala, FL patients ... implants are a nearly permanent, comfortable and efficient way for patients to replace their ... when placed by highly trained professionals such as Drs. Brand and Williams, providing patients ...
(Date:9/17/2019)... ... , ... Embr Labs , the breakthrough thermal technology company and creator ... DigiTx Partners, with participation from Safar Partners, Joyance Partners , Bose ... company’s footprint in wellness and digital therapeutics, accelerate development for the next generation of ...
Breaking Medicine Technology: