“It is so important to educate payers and providers about the downstream adverse events and long-term costs associated with steroid use.”
Lili Brillstein is an internationally recognized thought leader in the advancement of value-based approaches to specialty care. As founder and CEO of BCollaborative, her work focuses on enhancing patient experiences, improving care quality and promoting the efficient use of limited resources.
Brillstein’s career began with work on HIV discrimination and domestic violence. She never anticipated working for health insurance plans but found herself bridging the gap between business and clinical perspectives. Her goal was to choreograph a dance between these groups to improve member care and create predictability around costs.
At Horizon Blue Cross Blue Shield of New Jersey, Brillstein led the Episodes of Care program, focusing on specialty care in the value-based space. Her efforts focused on building models with, rather than for, doctors, fostering a collaborative environment. This approach built trust and partnership between providers and payers, transforming them into trusted advisors.
“In the fee-for-service model, physicians are paid for each unit of care they provide, regardless of patient outcomes. This often results in fragmented care, as doctors may be unaware of other treatments their patients receive. The focus is on individual services rather than the overall patient journey, leading to inefficiencies and lack of coordination.”
“In contrast, value-based care looks at the entire continuum of care, emphasizing outcomes rather than individual services. This model involves multidisciplinary teams focusing on optimal outcomes and minimizing variations in care. By leveraging longitudinal data, providers can identify and address inefficiencies, ultimately leading to better patient outcomes and cost savings.”
Brillstein emphasizes the importance of collaboration among stakeholders, including providers, payers and pharma. She aims to build partnerships that leverage the expertise of each participant to create functional and effective care models, moving away from the traditional adversarial relationships between payers and providers.
“We have a lot of disconnected, fragmented care that can be particularly difficult to navigate for patients living with chronic conditions. Clinicians want to do the right thing - they want to take care of their patients, but the payment structure does not always support their ability to do so.”
She has been particularly excited to bring this approach to the challenge of balancing short-term costs and benefits associated with steroid medications, with the medium to long-term risks and permanent damage they cause.
“Steroid medications, while effective in the short term, can lead to significant long-term adverse effects, such as glaucoma and osteoporosis. In the fee-for-service model, the focus on immediate results often overlooks these downstream consequences. In contrast, value-based care models consider the long-term outcomes and costs, aiming to optimize overall patient health.”
Brillstein highlights the importance of understanding the real cost of steroids beyond their initial affordability.
“It is so important to educate payers and providers about the downstream adverse events and long-term costs associated with steroid use. By emphasizing the use of steroid-sparing therapeutics and prioritizing comprehensive care, we can achieve better patient outcomes and more efficient use of resources.”
Brillstein’s work in value-based care models underscores the importance of collaboration, data-driven decision-making and focusing on long-term patient outcomes. Through her innovative approach, she continues to pave the way for a more efficient, patient-centered healthcare system that addresses the complexities of steroid use and improves care for patients with autoimmune and inflammatory diseases.
Lili Brillstein is an internationally recognized thought leader in the advancement of Episodes of Care as a value-based approach to specialty care. As the founder and CEO of BCollaborative, she fosters partnerships among payers, providers, start-ups and community organizations to support care models that emphasize collaborative, outcome-focused and resource-efficient healthcare delivery. Her work at BCollaborative aims to enhance patient outcomes and experiences while ensuring the optimal use of resources through innovative partnerships.
Previously, Brillstein played a pivotal role at Horizon BCBS of New Jersey, leading the Episodes of Care program to become the largest and most advanced value-based care initiative for specialty care in the United States. Her contributions extend to academia and policy development; she has been a guest lecturer at Harvard Business School, worked with esteemed professionals such as Michael Porter, and co-authored publications on value-based care. She has collaborated with CMMI and PTAC on specialty care models and has served 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 a former 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.