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Value-Based Programs

As the state’s largest and most experienced health insurer, Horizon BCBSNJ is leading the transformation of health care delivery in New Jersey. We are committed to creating innovative physician/hospital-payer agreements that foster value-based care.

Our Value-Based Programs are deeply rooted in the fundamentals of the triple aim – improving patient outcomes, enhancing the patient experience and reducing overall costs.

Doctors and hospitals that are part of our Value-Based Programs coordinate patients’ health care needs and help ensure patients receive the highest quality of care in the right setting and at the right time. This patient-centered approach provides personalized and comprehensive health care that allows patients to become engaged in their health care. Participation in our program does not decrease or limit any current benefits.

Transforming Care: Horizon BCBSNJ and Vanguard Medical Group
Learn how Horizon BCBSNJ is working with providers to transform health care in New Jersey.

Episodes of Care
Episodes of Care (EOC) is the primary model that Horizon BCBSNJ uses to engage specialty care physicians in our value-based strategy. In an EOC, a practice or doctor acts as the conductor who orchestrates the full spectrum of care for a specific medical condition, procedure or illness within a defined period of time. The focus is on coordinated, collaborative care across the health care continuum to ensure that patients receive the highest quality and most comprehensive care. Using outcome measures developed in conjunction with our physician partners, our goals are to achieve the best long-term outcomes, create experiences that patients feel good about and reduce the total cost of care by eliminating unnecessary care.

EOC is an innovative care model that:

  • Promotes physician-directed medicine;
  • Creates accountability to the patient for all care related to their particular procedure, diagnosis or health care event;
  • Promotes collaborative, comprehensive “best-in-class” care for Horizon BCBSNJ members across the full continuum;
  • Supports the view that health care is about best outcomes;
  • Promotes clinical outcomes and cost transparency to inform optimal care delivery decisions;
  • Enhances collaboration of all care providers across multiple care settings.