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Value-Based Payments Help Manage
Costs & Improve Care Outcomes

  • April 22, 2021
  • 2:00 PM – 3:00 PM ET
  • Online
about

Now more than ever, health insurance providers recognize the need to move from traditional fee for service (FFS) models to Value Based Payments (VBP) programs to help deliver better, coordinated care for patients, while controlling costs. This not only applies to primary care services, but also to the care of complex conditions, and the management of members’ social determinants of health. However, developing an approach that addresses the various needs of key stakeholders can be daunting and complex.

During this webinar, attendees will hear from Horizon Blue Cross Blue Shield of New Jersey about their road to VBP that began 12 years ago and now serves 1.6 million members through an expansive Total Cost of Care program, which includes more than 26 episodes of care programs, and a social determinants of health (SDoH) program partnership with eight large community/hospital systems.

Presenters will describe program results which have positively impacted cost, quality, and satisfaction across the organization. They will also describe key elements involved in the growth of the programs—including provider engagement, population health innovation, the ongoing development of episodes and risk-sharing arrangements, and lessons learned.

Attendees will learn about:

  • Key elements involved in the development of a VBP program based on lessons learned
  • How SDoH can be applied to manage chronic conditions more effectively
  • The role of data in driving constant improvements

Speakers


Andrei Gonzales, MD
Assistant Vice President, Product Management, Value-Based Payments
Change Healthcare

Andrei is responsible for product management of HealthQx and providing strategic context and input to the Change Healthcare portfolio. With over 12 years of experience at Change Healthcare, Dr. Gonzales manages customer engagements and provides expert guidance to help customers develop and establish pilot programs using the Episode Management solution. He earned his medical degree from University of Washington School of Medicine and a BA in Biology from Pomona College.


Florence Kariuki, RN BSN MHA
Director, New Models and Episodes of Care Programs
Horizon Blue Cross Blue Shield of New Jersey

Florence is a nursing leader responsible for crafting the strategy, design, and implementation of Episodes of Care programs and other innovative Alternative Payment Models. Among other initiatives, Ms. Kariuki also led the design and implementation of Horizon’s Enterprise-wide Social Determinants of Health (SDoH) and Home-Based Palliative Care programs, as well as Population Health initiatives focused on improving transitions of care, optimizing Care Coordination infrastructure, and reducing potentially avoidable hospital utilization.

She received her Bachelor of Science in nursing (BSN) from William Peterson University, Master of Arts, Health Care Administration (MHA) from Seton Hall University.


Lisa L. White, MS, ACHE, SSGB
Director of Value-Based Transformation
Horizon Blue Cross Blue Shield of New Jersey

Lisa is an innovator and change agent for value-based programming in all lines of business. Ms. White is entrusted with bringing forth the right mix of initiatives and accountabilities to serve plan members and provider partners in equal measure, rooted in established Triple/Quadruple Aim goals. With a passion for creating a more sustainable and effective national healthcare system, her enthusiasm centers around addressing old questions in new ways. Her experience includes corporate benefits administration, physical therapy, long-term care, pharmacy, and both Medicaid and Commercial health plans.

She received her Bachelor of Science in Biology and Chemistry from Georgia State University and is a graduate of the University of Illinois at Chicago Medical School’s Patient Safety M.S. program.

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