Horizon BCBSNJ touts promising results for shared-savings initiative

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through its Episodes of Care (EOC) program.

The insurer paid the doctors for achieving quality, cost efficiency and patient satisfaction goals in 2014, the announcement said. The physicians and Horizon BCBSNJ collaborated to determine the best approach in care delivery while reducing costs and enhancing the medical experience for patients. 

For 2014, Horizon BCBSNJ reviewed claims data for members receiving care from both an EOC practice and those receiving the same procedure from a non-EOC practice. It found that members who were in EOC practices had a far lower hospital readmission rate as compared to members receiving the same services from a non-EOC practice.

There were 100 percent fewer hospital readmissions for knee arthroscopy, 37 percent fewer hospital readmissions for hip replacement, 22 percent fewer hospital readmissions for knee replacement and 32 percent 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." Lili Brillstein, director of Horizon EOC program, said in the announcement.

Not all of Horizon's initiatives to trim healthcare costs have been well-received, however. Its new tiered physician network called the Omnia Health Alliance angered some New Jersey providers that claimed its process for choosing tier 1 hospitals was neither fair nor transparent. The insurer, however, has defended the initiative.

To learn more:
- here is the Horizon BCBSNJ announcement