HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY Lili Brillstein is a nationally recognized thought leader in the advancement of Episodes of Care as a value-based approach for specialty care. She is the Director of Specialty Care Value Based Models for Horizon Blue Cross Blue Shield of New Jersey, and, under her leadership, has built the largest, most progressive and most collaborative program for commercially insured patients in the country.
Lili is responsible for the overall direction, strategy, design and oversight of the Horizon Episodes of Care/Bundled Payment Program. When Lili joined Horizon in January of 2013, the Episodes program was still in pilot and included only total hip and total knee replacement episodes. The program has grown to include additional orthopaedic episodes (including low back/laminectomy, shoulder replacement, knee arthroscopy), obstetrics and gynecology, GI (including an IBD episode with a fully integrated behavioral health component), cardiology, oncology, and substance use disorder.
Lili is a passionate advocate of Episodes of Care/Bundled Payments as a strategy to successfully migrate from fee for service to quality- & value-based models that rewards providers for excellent outcomes and patient experience, while reducing the overall cost of healthcare. One of the hallmarks of her perspective is the criticality of beginning with models that do not include a risk transfer to providers until all of the stakeholders have worked together in a retrospective, no risk model and achieved success. The goal is cultivate true partnerships aligned around the patient and improve their experiences and outcomes, and ultimately reduce unnecessary care and waste.
Lili is a guest lecturer on episodes of care/bundled payments at the Harvard Business School working with Michael Porter and team, and has co-authored several peer-reviewed articles on the subject of Episodes. In addition, Lili has served as an Advisor to CMS on bundled payments, and is on the Advisory Boards of the US Women’s Health Alliance and the Quality Cancer Care Alliance; both national coalitions focused on advancing value based care to improve quality and cost of care delivery. She is also an Adjunct Associate Professor at The Rutgers School of Pharmacy, and a member of the Board of Directors for the NJ Coalition to End Domestic Violence.
Lili’s expertise at cultivating functionally collaborative relationships between payers and providers across the full continuum of health care has allowed not only the pillars of the triple aim to be achieved, but the spirit of the relationships to shift from one of adversaries to one of collaborators.
