Horizon Blue Cross Blue Shield of New Jersey paid out $3M to 51 specialty medical practices—an average of about $59,000 per practice—due to shared savings in its Episodes of Care (EOC) program. In a press release, Horizon said the EOC model uses specialists to coordinate care related to a specific procedure, such as a joint replacement or pregnancy.
“The physicians and Horizon BCBSNJ define the episode components and determine the quality of care outcomes,” Horizon said. “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.” Horizon rewards providers who meet this Triple Aim with shared savings.
For 2014, Horizon reviewed calling data for members receiving care from an EOC practice and compared them to patients receiving care from a non-EOC practice. They found:
-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
“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.”
Horizon BCBSNJ has 800,000 members tied to value-based programs, including EOC, patient-centered medical homes and ACOs.