How Payers and Healthcare Providers are Making Peace
Despite a legacy of mistrust, leading organizations are working together and building trust by using benchmarking, bundling, and aligning their interests.
This article first appeared in the May 2016 issue of HealthLeaders magazine.
After decades of fee-for-service-fueled adversarial relations, healthcare providers and payers are learning how to work together cooperatively.
One blooming partnership between a prominent payer and physician groups is rooted in New Jersey.
"We see relationships with providers now that are nothing like anything we have seen in managed care before," says Lili Brillstein, director for episodes of care for Horizon Healthcare Innovations, a division of Newark-based Horizon Blue Cross Blue Shield of New Jersey. "We are so proud of what we have been able to accomplish."
In 2014, Horizon posted total revenue at $9.5 billion and capital reserves at $2.5 billion. The health plan serves about 3.8 million members.
As of February 2016, Horizon says it had more than 900 physicians participating in episodes of care programs for several medical conditions and procedures: hip and knee replacements; knee arthroscopy; coronary artery bypass grafting (CABG); maternity; hysterectomy; colonoscopy; breast, lung, and colon cancer; and congestive heart failure.