Horizon BCBSNJ Creates Groundbreaking Patient-Centered Program for Cancer Treatment

On Oct 21, 2014

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced today that it has joined with Regional Cancer Care Associates (RCCA) – one of the nation’s largest oncologist physician groups – to create an Episode of Care (EOC) program to deliver highly specialized care for breast cancer patients.  RCCA physicians, more than 100 specialists at 24 New Jersey locations, will be compensated on the quality, not quantity, of care their breast cancer patients receive.

The new EOC program, which began on October 1, uses a real-time data platform, developed by COTA, Inc, that customizes treatment by categorizing a patient’s cancer by molecular subtype.  The COTA platform also supports the effort to move from a fee-for-service to value-based reimbursement system for physicians.

“Breast cancer is a highly complex disease that is complicated to treat because not all therapies and treatments work uniformly for all patients, even though patients may be similarly diagnosed or in the same stage of illness,” Glenn D. Pomerantz, MD, JD, Vice President and Chief Medical Officer of Horizon BCBSNJ. “This Episode of Care program has great potential to apply COTA’s technology to identify the specific molecular characteristics of a patient’s condition so treatment can be individualized, which will lead to better care quality, improved coordination, and a better patient outcome.”

Horizon BCBSNJ is leading an effort, through its patient-centered programs, to transform how health care is delivered in New Jersey. Horizon BCBSNJ’s patient-centered programs focus on delivering more coordinated and efficient patient care, and improving the satisfaction of patients. More than 500,000 Horizon BCBSNJ members receive treatment from 3,700 patient-centered physicians at 900 practice locations across the state. Horizon BCBSNJ’s other EOC programs include hip and knee joint replacement, orthoscopic knee surgery, pregnancy and delivery, and colonoscopy.

“The health care system is uniquely challenged by traditional oncology reimbursement, making it more difficult to improve patient outcomes and at the same time, control the high cost of cancer treatment,” said Andrew L. Pecora, M.D. FACP CPE, President of Regional Cancer Care Associates. “Payers and providers are ready to move forward, on behalf of patients, and test at-risk bundle payments where the total cost and service provided is fixed up front, transparent, and tied to desired outcomes. At-risk bundle payments hold promise because cost and outcomes are monitored and reported in real-time. This payment model will help improve quality and control cost growth by using outcomes tracking and reporting.

RCCA will achieve these objectives through this new partnership with Horizon and we are excited to improve patient care together.”

Oncologists participating in this EOC will closely monitor and work with other health professionals in the full-spectrum of cancer care to ensure patients receive high-quality care and an exceptional experience during their episode. If the participating doctors meet quality and efficiency goals, they may be eligible to share in the resulting savings.

“Our goal is to improve coordination, communication and collaboration across the full continuum of care, and this program will allow physicians to more precisely compare patients’ treatments and outcomes for purposes of maximizing quality and standardizing breast cancer patient care,” Pomerantz said.

“Horizon’s episode of care or bundled payment program is at the leading edge of such programs in the country,” noted François de Brantes, Executive Director of the Health Care Incentives Improvement Institute. “By engaging physicians and hospitals in a true partnership focused on improving the quality and affordability of health care, Horizon is setting an example that others should emulate to accelerate the transformation of the U.S. healthcare system.”

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