Horizon Blue Cross Blue Shield of New Jersey has launched the state's first patient-centered pregnancy and delivery episode of care program designed to bring about better outcomes, patient experience and lower costs through better coordination of care for pregnant women.
Horizon BCBSNJ joined with 190 of their network OB-GYN physicians to operate similar to a coach directing a team by leading and organizing the full spectrum of care for a patient's pregnancy, delivery and post-delivery recovery. Horizon BCBSNJ will reimburse the participating practices at an agreed-upon amount and the physicians may be eligible for shared savings if they meet program aims.
"Keeping babies healthy begins long before delivery, and the new program is focused on improving the mother's – and her family's – experience throughout the duration of her pregnancy and delivery with more coordinated, quality care," said Jim Albano, vice president of network management and Horizon healthcare innovations at Horizon BCBSNJ.
Payers and providers are beginning to amass data and rack up more experience as organizations increasingly trend towards partnerships with new payment models. Highmark reported that in the first year of enrollment in its Accountable Care Alliance and medical home, until October 2013, practices showed a 26 percent improvement in scores for clinical quality performance measures. The practices also reduced medical costs with a total six months savings of about $11.5 million.
The data "demonstrates that the programs are working," even in the limited time period, said Mike Fiaschetti, Highmark's president of health markets, in a news release. The Blue affiliate operates in Pennsylvania, Delaware and West Virginia.
Highmark has 540 practices representing 3,000 practitioners in the Accountable Care Alliance and patient-centered medical home (PCMH), which the payer will expand "aggressively" in the next year.
Blue Cross and Blue Shield of Georgia and Blue Cross Blue Shield Healthcare Plan of Georgia (collectively BCBSGa) and Emory Healthcare, the state's largest healthcare system, have launched an accountable care organization agreement. It will incorporate Emory-employed and private practice physicians throughout metro Atlanta and throughout the state. The value-based relationship will give Emory physicians access to BCBSGa patient data to improve care coordination and increase patient engagement, said Morgan Kendrick, BCBSGa president, in a news release.
The bi-directional communication between provider and payer supports care coordination, risk-stratified care management, wellness and prevention and shared decision making with patients and their caregivers.
Florida Blue and First Coast Health Alliance, including Flagler Hospital and its 188 community physicians, have agreed to an accountable care arrangement in St. Johns County and Jacksonville. As of Jan. 1, it is designed to decrease medical costs and increase quality outcomes by rewarding the right combination of goals, including transparency, care coordination, consumer empowerment and lack of redundancy.