Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

Lili BrillsteinWhile it does not immediately eliminate fee for service, a retrospective upside-only payment model is helping to transform the spirit of the payor-provider relationship, notes Lili Brillstein, director of the Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) Episodes of Care (EOC) initiative where this methodology has been implemented.

Listen as Ms. Brillstein describes how Horizon’s application of retrospective methodology across all episodes expands the program’s reach and opportunities while fostering a no-risk environment conducive to collaboration.

During a March 2016 webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, now available for replay, Ms. Brillstein shares details behind the health plan’s EOC program, from the episodes they have bundled to goals and results from the program.


Length: 4:12 minutes

Transitions Leadership Group Maps Patient Moves through St. Vincent’s Network Continuum

Colleen SwedbergAs groundwork for participation in CMS’s Bundled Payments for Care Improvement initiative, St. Vincent’s Health Partners (SVHP) formed a cross-functional cross-boundary Transitions Leadership Group to map what happens to patients moving along their care journeys, explains Colleen Swedberg, MSN, RN, CNL, director for care coordination and integration.

In this audio interview, Ms. Swedberg describes the structure and goals of the Transitions Leadership Group and some tools and protocols it developed to set standards for any post-acute provider wishing to join the SVHP network.

During a September 2015 webinar, Post-Acute Care Trends: Aligning Clinical Standards and Provider Demands in the Changing Landscape, now available for replay, Ms. Swedberg and Julia Portale, vice president of community services, Jewish Senior Services, share their organizations’ collaborative approaches to the evolving post-acute care market.


Length: 4:03 minutes

Post-Acute Bundled Payments Opportunity to Identify Gaps in Care, Staff Training

Debbie ReberBeyond reducing per-episode costs and readmissions, Brooks Rehabilitation’s experience in CMS’s Bundled Payments for Care Improvement (BPCI) initiative helped the post-acute care provider to identify gaps in care and staff training, notes Debbie Reber, vice president of clinical services for Brooks Rehabilitation.

In this audio interview, Ms. Reber identifies how Brooks Complete Care program achieved its biggest savings as well as the care and training enhancements resulting from the rehabilitation system’s participation in BPCI’s Model 3.

During a July 2015 webinar, Bundled Payments for Post-Acute Care: Four Critical Paths To Success, now available for replay, Debbie Reber shares the inside details on the four domains of Complete Care and the resulting, significant savings Brooks achieved through the BPCI program.


Length: 3:26 minutes

Data Integration, Physician-Hospital Alignment Crucial to Bundled Payment Success

An increase in the number of physician practices as episode initiators will improve physician-hospital alignment in bundled payment initiatives, as will leveraging the gain-sharing waiver on offer to participants in Model 2 of the Center for Medicare and Medicaid Innovation (CMMI) bundled payment pilot, advises Kelsey Mellard, vice president of partnership marketing and policy with naviHealth, a convener in the Model 2 pilot, which went live in January.

In this audio interview, Ms. Mellard also identifies strategies for efficient and timely data collection across a bundled payment episode, including cultivation of relationships among pre- and post-acute providers across an episode community.

Alignment of physicians and hospitals and the harnessing of performance data were two challenges associated with bundled payments identified by a 2013 KPMG poll of more than 200 hospitals and large physician groups.

Kelsey Mellard shared first quarter experiences from Model 2 pilot programs, along with current opportunities for organizations not yet participating in bundled payment pilots during a May 21, 2014 webinar, Bundled Payments: Opportunities in Effective Retrospective Acute and Post-Acute Care Bundles, a 45-minute program, now available for replay, sponsored by The Healthcare Intelligence Network.


Length: 6:47 minutes

Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal “Better Care, Lower Cost Act” of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS’ recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable.

Greg Mertz helped healthcare organizations assess which value-based healthcare delivery model is right for their organization during Physician Alignment: Which Model Is Right for You?, a February 19th, 2014 workshop at 1:30 p.m. Eastern.


Length: 5:58 minutes

Healthcare Trends & Forecasts in 2014: 7 Payor Strategies That Will Reshape Primary Care

From partnering with non-traditional providers like retail clinics to targeting larger physician practices to achieve savings and boost health outcomes, watch for health plans to continue to reshape primary care delivery over the coming year, predicts Catherine Sreckovich, managing director, healthcare, Navigant. Ms. Sreckovich outlines seven ways in which payors will influence primary care, advocates for big data for both payors and providers, and comments on the longevity of the bundled or episodic payment trend in this HealthSounds interview.

Catherine Sreckovich and Steven Valentine, president of The Camden Group, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.


Length: 7:37 minutes