A year-and-a-half after launch, Regence’s innovative Episodes of Care program is adding new providers, employers and procedures across two states and delivering significant savings, improved patient outcomes and greater provider collaboration.
To date, the program has driven 16 percent cost savings for episode-attributed orthopedic procedures, as compared to the historical costs of those procedures, while enabling the continued delivery of low-complication, high-quality care. And Regence’s largest customer, the Washington State Health Care Authority (HCA), recently joined Episodes of Care, effective January 2022.
Episodes of Care, Regence’s first value-based arrangement (VBA) to cover clinical procedures, now includes orthopedics, cardiac procedures, gastrointestinal conditions and maternity care. The program compensates providers for delivering improved patient outcomes and lower costs over a patient’s “episode of care” for a procedure or condition – such as a knee replacement or cardiac procedure – over a defined period of time.
“Our charge with Episodes of Care is to work closely with providers to deliver a better coordinated experience and lower costs for patients,” said Dr. Marion Couch, senior vice president of Health Care Services and chief medical officer for Regence. “Early results and the addition of major employers and new procedures are adding to the program’s momentum and will ultimately help us bring this innovative care approach to more people across our region.”
Regence’s partner in Episodes of Care is Signify Health, which administers episode-based payment programs and supports providers and payers to improve episode outcomes.
The addition of 363,000 HCA members to Episodes of Care further aligns HCA, Regence and Signify in their shared goals of making health care more affordable, more transparent and more efficient.
“Having a patient-centered care plan that supports the needs of each person is central to the success of the Episodes of Care program,” said Laurel Douty, executive vice president, clinical operations for Signify Health. “By collaborating with clinicians to provide high-quality, high-value clinical care and aligning incentives to achieve optimal patient outcomes, Regence and HCA demonstrate true partnership in care delivery and a focus on providing an excellent experience throughout the care journey.”
HCA is Washington’s largest purchaser of health care, and its Public Employees Benefits Board (PEBB) Program and School Employees Benefits Board (SEBB) Program health plan members include public employees, school employees, retirees and their eligible dependents. HCA is committed to containing costs while improving outcomes, patient and provider experience, and equity through innovative value-based purchasing strategies.
“As we continue our value-based purchasing journey, the Episodes of Care program is a great example of what we want to focus on: delivering improved patient outcomes and experiences, coordinated care, and lower costs,” said Dr. Judy Zerzan, chief medical officer for the Washington State Health Care Authority.
Episodes of Care providers are incentivized to look at the full end-to-end continuum of care. They strive to deliver coordinated, high-quality care at a lower cost throughout the course of an entire health episode, which could range from 30 days to a year.
Since 2013, Regence has been increasing its number of value-based arrangements, which tie provider payments to quality versus quantity of care. Regence’s VBAs across its four-state footprint have shown significant improvements in care outcomes and savings over more traditional payment models.
Regence serves approximately 3.3 million people through its health plans in Idaho, Oregon, Utah, and Washington. Each Regence health plan is a nonprofit independent licensee of the Blue Cross and Blue Shield Association. Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. For more information, please visit regence.com.
About Signify Health
Signify Health (NYSE: SGFY) is a leading healthcare platform that leverages advanced analytics, technology, and nationwide healthcare provider networks to create and power value-based payment programs. Our mission is to transform how care is paid for and delivered so that people can enjoy more healthy, happy days at home. Our solutions support value-based payment programs by aligning financial incentives around outcomes, providing tools to health plans and healthcare organizations designed to assess and manage risk and identify actionable opportunities for improved patient outcomes, coordination and cost-savings. Through our platform, we coordinate what we believe is a holistic suite of clinical, social, and behavioral services to address an individual’s healthcare needs and prevent adverse events that drive excess cost, all while shifting services towards the home. For more information on how we are taking health homeward, visit us at signifyhealth.com.
Signify Health is a separate and independent company that administers episode-based payment programs for Regence members.