Regence Scaling Up Episodes of Care Program

Pacific Northwest insurer Regence says its Episodes of Care program is growing and improving patient outcomes and provider collaboration. Regence’s largest customer, the Washington State Health Care Authority (HCA), announced it is joining Episodes of Care, effective January 2022, adding 363,000 HCA members to Episodes of Care.

Regence serves approximately 3.3 million people through its health plans in Idaho, Oregon, Utah, and Washington. Launched a year and a half ago, Episodes of Care, its first value-based arrangement to cover clinical procedures, includes orthopedics, cardiac procedures, gastrointestinal conditions and maternity care. The program compensates providers for delivering improved patient outcomes and lower costs over a patient’s “episode of care” for a procedure or condition – such as a knee replacement or cardiac procedure – over a defined period of time. The providers are incentivized to look at the full end-to-end continuum of care.

To date, Regence says, the program has driven 16 percent cost savings for episode-attributed orthopedic procedures, as compared to the historical costs of those procedures, while enabling the continued delivery of low-complication, high-quality care.

“Our charge with Episodes of Care is to work closely with providers to deliver a better coordinated experience and lower costs for patients,” said Marion Couch, M.D., senior vice president of Health Care Services and chief medical officer for Regence, in a statement. “Early results and the addition of major employers and new procedures are adding to the program’s momentum and will ultimately help us bring this innovative care approach to more people across our region.”

Regence’s partners with Signify Health, which administers episode-based payment programs and supports providers and payers to improve episode outcomes.

HCA is Washington’s largest purchaser of health care, and its Public Employees Benefits Board (PEBB) Program and School Employees Benefits Board (SEBB) Program health plan members include public employees, school employees, retirees and their eligible dependents. HCA says it is committed to containing costs while improving outcomes, patient and provider experience, and equity through innovative value-based purchasing strategies.

“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, chief medical officer for the HCA, in a statement.