Terms of engagement
A value-based specialist model drives down costs and improves quality for orthopedic patients
Physicians participating in Horizon BCBSNJ’s Episodes of Care (EOC) program outperformed non-EOC colleagues for the same procedures in outcomes, quality and cost.
The finding is based on an analysis of 2017 data for patients enrolled in Horizon BCBNJ’s EOCs for hip replacement, knee replacement and knee arthroscopy.
EOC is the model used to engage specialists in the Newark-based company’s value-based strategy.
The idea was to drive improved outcomes and patient experience and ultimately reduce the overall cost of care.
Doctors who choose to participate in the program are rewarded for achieving better quality of care, lower costs and a more positive patient experience.
When EOC specialists achieve those triple goals, Horizon shares cost savings that they receive in addition to their fee-for-service reimbursements.
“The idea was to drive improved outcomes and patient experience and ultimately reduce the overall cost of care,” said Lili Brillstein, director of specialty care value based models for Horizon BCBSNJ.
Brillstein said that there has been interest in the program — not only in New Jersey but also all over the country.