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Horizon's value-based incentive program pays $3M to specialists

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A value-based program's success resulted in $3 million in shared savings paid out by Horizon Blue Cross Blue Shield of New Jersey.

The state’s largest insurer worked with 51 specialists statewide to help improve outcomes, reduce readmissions and lower the cost of care — and the results of 8,000 patients in 2014 show value-based incentives have positive results, according to a statement Tuesday.

The specialists were paid a cumulative total of $3 million for success in the Episodes of Care program for 2014, Horizon said in a statement.

Looking at five procedures that have a higher occurrences or readmissions, Horizon claims show significant reductions for specialists who participated in the program compared to non-EOC practices.

There were 100 percent fewer hospital readmissions for knee arthroscopy, 37 percent fewer for hip replacement, 22 percent fewer for knee replacement and a 32 percent reduction in unnecessary C-section deliveries.

Following the success with these four, as well as colonoscopies, Horizon is now adding more procedures to the program, including heart failure, hysterectomy, lung cancer, breast cancer and colon cancer.

“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 the 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.”

The specialists received the bonus from shared savings on top of their traditional fee-for-service reimbursements. But the new incentive model is being applauded by users.

“The Episodes of Care model is a game-changer in the progress from fee-for-service to value-based contracting,” said Charles Accurso, a Hillsborough gastroenterologist who is part of the Horizon program. “By tying financial incentives to quality, it improves the care of the patient while also decreasing costs.”

This program is the latest in six years from Horizon, which now offers value-based programs used by 800,000 members as of 2015, it said in a statement.

“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. “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.”

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