Patient Testimonial: Lewis Cullen
Knee Replacement at Shore Medical Center
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.
Shore Medical Center:
“Shore Healthy Living” Newsletter
Knee replacement surgeries are a daily occurrence for Dr. Stephen Zabinski and his fellow orthopedic surgeons at Shore Orthopaedic University Associates (SOUA) in Somers Point. “Knees are by far the most common of all joints that are replaced,” said Dr. Zabinski who has been performing knee replacement surgery for more than 20 years. “Knees are also the joint most commonly affected by osteoarthritis. They are also the most subjective to sports injury and most affected by weight. Those factors can wear the knees away.”
Most patients will visit SOUA with complaints of discomfort from osteoarthritis, though there are many forms of arthritis that negatively impact joints and bones. Osteoarthritis is the most common form of arthritis in the knee. It is a degenerative, “wear-and-tear” type of arthritis where the cartilage gradually wears away. It occurs most often in people age 50 and older, but may occur in younger people as well, according to the American Academy of Orthopaedic Surgeons. Dr. Zabinski added that genetics also plays a factor and said people who tend to sit cross-legged as they eat, or kneel often may have significant discomfort in their knee simply because they are putting a lot of additional stress on the knee itself.
Ellen Deegan, Somers Point, NJ