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Trinitas Regional Medical Center is going to be dropping out of the lawsuit it has against the state’s largest insurer following the announcement of a new value-based partnership, according to CEO Gary Horan.Trinitas is the latest to join a value-based reimbursement partnership with Horizon Blue Cross Blue Shield of New Jersey.

The new collaboration will focus on patients with congestive heart failure when it launches later this year, according to a joint statement from Horizon and Trinitas.

The partnership is part of Horizon’s Episodes of Care program, which focuses on value-based care to help reduce costs to patients and improve quality, according to the statement.

“Trinitas has served the health needs of Central and Northern Jersey for more than 100 years, and we’re excited to team up with Horizon to expedite our transition to value-based care. This strategic collaborative represents an aggressive strategy to increase access to primary care, better integrate primary and behavioral health services, and deliver care more effectively and efficiently to the people we serve,” said Gary Horan, CEO and president of Trinitas. “Trinitas and Horizon have a long history of working together to better the health and lives of the people of Elizabeth and Central Jersey. Value-based care is clearly the direction in which medicine is heading and we’re excited to join Horizon at the forefront of bringing the benefits of this approach to our patients.” 

Next year, the program at Trinitas will expand to include coronary artery disease and care for diabetes.

The episodes of care chosen correlate to the largest volumes of service for the hospital and will help reduce readmissions, Horan said.

“There is a new health care environment, there is no question about it. We all have to be part of the same mindset to provide the highest quality at the lowest possible price,” Horan said.

He said the episodes of care also help with a program Trinitas already has in place which involves paramedics visiting homes of high-risk patients and ensuring they are following prescribed diets and medication.

But the relationship between Horizon and Trinitas will go beyond just the episodes of care, into working on a care model to integrate primary care and behavioral health, as well as working on reducing costs of care for people insured through Medicaid.

“Joining the Horizon value-based care effort will give us access to data that multiplies our knowledge base and accelerates our ability to integrate the clinical practices that achieve the best possible outcomes for our patients. Working with Horizon, we’ll be able to leverage data and translate that depth of experience into treatment plans that improve outcomes, reduce the cost of care, and lead to happier, healthier patients,” Horan said.

Horizon also has an Episodes of Care partnership with University Hospital in Newark to help improve outcomes in maternity care.

St Luke’s Warren Campus, which also recently dropped out of the lawsuit against Horizon, is in talks for a similar value-based arrangement.

“St. Luke’s has been in discussions with Horizon for a direct provider contract dating back to 2012 with the ultimate intent of establishing a value-based arrangement, which will facilitate delivery of the high level of cost-effective care St. Luke’s is known for and Horizon enrollees desire. St. Luke’s looks forward to a healthy relationship with Horizon, with a focus on how St. Luke’s can offer these outcomes to Horizon participants for the foreseeable future,” St. Luke’s said in a statement to NJBIZ, adding that the health network already has value-based arrangements in Philadelphia.

“Horizon is committed to working with hospitals that want to collaborate with us to do even more to improve care quality, enhance the patient experience and control health care costs. We’re in active discussions throughout the state with providers interested in creating value-based care relationships,” Horizon said in a statement.

Horan said that the two entities have had a long-standing relationship prior to the tussle over OMNIA, and it makes sense to continue that relationship.

“Horizon has nearly 4 million insured and the number prescribed to the OMNIA plan is about 235,000. That means 3.7 million are not enrolled in OMNIA and we participate in so many other plans that it doesn’t make sense” not to drop the lawsuit, Horan said.

Episodes of Care is one of the various value-based reimbursement programs at Horizon.

Earlier this year, Horizon released information underscoring the success of the programs.

In helping improve outcomes for patients, 51 specialists were paid a cumulative total of $3 million for success in the Episodes of Care program for 2014, Horizon said in a statement in February.