Regence BlueShield expands value-based program that cut orthopedic costs by 16%

Payer Issues

Seattle-based Regence BlueShield is adding more providers and covering more procedures in its Episodes of Care value-based care program, which launched in January 2020.

Since its launch, the program has decreased the cost of orthopedic procedures by 16 percent, compared to the historical costs of those procedures, the payer said in an Aug. 10 news release.

In January 2022, the four-state insurer's largest customer, the Washington State Health Care Authority, will join the value-based program, bringing 363,000 members with it.

Episodes of Care is Regence's first value-based arrangement to cover clinical procedures, and now includes orthopedics as well as cardiac procedures, gastroenterology and maternity care. The program compensates providers that deliver improved outcomes and lower costs — for procedures such as knee replacements or cardiac cases — over a defined period of time.

"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 Judy Zerzan, MD, CMO of Washington State Health Care Authority.

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