Proprietary and Confidential This Document is Proprietary and Confidential Do Not Print or Distribute Without Permission Episodes of Care A Value-Based.

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Proprietary and Confidential This Document is Proprietary and Confidential Do Not Print or Distribute Without Permission Episodes of Care A Value-Based Model for Specialty Care Kim D. Eason Manager, Episodes of Care NJSOM Annual Conference – June 1, 2016 – Atlantic City, NJ

Episodes of Care Value-based model designed to engage specialists and refocus health care delivery and reimbursement on quality and value rather than volume. Full spectrum of health care services related to, and delivered, for a specific medical condition, illness, procedure or health care event during a defined time period.

Fee-for-Service vs. Episodes of Care FFS: Focus is on all of the care provided by a particular provider. EOC: Focus is on all of the care provided to a particular patient.

EOC Primary Goal Standardize & optimize care and cost-of-care Compare like patients and like outcomes Study variation in utilization and cost of care

Horizon is a National Leader in Advancing the EOC Model W We Participate in and Lead National Discussions around EOC National Advisory Panel Participation CMS Advisory Panel for Oncology Bundles Brookings Inst/CMS Panel for GI Bundles CMS Advisory Panel for Rad Onc Bundles MEDPAC Advisor Trizetto Payment Bundler National Payer Advisory Committee – Former Chair AGA Task Force on Bundled Payments Publications Referencing HBCBSNJ EOC Program Health Affairs American Journal Managed Care AIS Health ASC Review Managed HealthCare Executive HCI3 Issue Briefs NJ Biz Program Advisor to Other State Plans, Providers & Vendors Regence BCBS Michigan Blues South Carolina Blues Minnesota GI Practice Providence Health McKesson BCBS NC Conference Speaking Engagements AHIP Nat’l Bundled Payment Summit Blue National Summit ISPOR TriZetto Executive Vision Summit Bundled Payment Congress US Women’s Health Alliance Oregon HFMA NJ Ambulatory Surgery Center Annual Conference AIS National Webinar

Horizon BCBSNJ’s EOC Success Retrospective Program has allowed for significant improvement in relationships between Horizon BCBSNJ and our providers. Completely changed the spirit of the interactions Brought us closer to what managed care was intended to be Allowed for an evolution of change that has resulted in: Improved quality Improved patient experience Reduced overall costs

What Is New- Future State Enhanced Technology Oncology Care Model (OCM) – Horizon’s Current Status Joining The Horizon EOC Program

Open Discussion Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2016 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey The entire document is proprietary & confidential.