Health System Joins Blue Cross NC to Expand Value-Based Care

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Mission Health have signed an agreement that will expand the benefits of value-based care to members across Western North Carolina and increase access to care for Medicaid beneficiaries.

Once the contract takes effect on January 1, 2022, Mission Health will join Blue Premier, Blue Cross NC’s value-based care program which ensures that providers are paid for the quality of care they provide, not the quantity.

Blue Cross NC members in western North Carolina currently may receive care from six hospitals and over 1,000 physicians that are part of Mission Health’s system. This collaboration will provide members with high-quality, coordinated care that is more affordable, according to the press release.

“These new agreements show that Blue Cross NC and Mission Health share the same goals for our members: health care that is better, simpler and more affordable,” said Dr. Tunde Sotunde, president and chief executive officer of Blue Cross NC.

“We value the great working relationship we have with Mission Health as both organizations strive to improve the health and well-being of the communities.”

Blue Premier has agreements with 11 health systems and more than 870 independent care practices in North Carolina. Blue Premier aims to help expand value-based care across the state. In 2019, the year that the program was launched, Blue Premier and Blue Cross NC helped save an estimated $153 million in costs.

Blue Premier is unique from other value-based care programs in that their agreements with health systems cover several years and advance toward shared financial risk between Blue Cross NC and providers. Ensuring that providers and insurers are on the same page and have the same goals produces better and more affordable care for patients.               

Once this contract takes effect, eight of the ten largest healthcare systems in North Carolina will have value-based contracts with Blue Cross NC through Blue Premier.

As another result of the agreement between the two organizations, Mission Health is now part of Blue Cross NC’s Healthy Blue Medicaid provider network. Members will receive healthcare services under the new Medicaid managed care program starting on July 1, 2021.

This agreement will expand access to care for Medicaid beneficiaries across the state. Healthy Blue has a network of more than 48,000 providers, including most of the hospitals and health systems in North Carolina.

Medicaid managed care programs, like Healthy Blue, can also cover transportation services, offer rewards from provider visits, and reimburse for fresh vegetables and fruits for three months up to $120, according to a past press release.

Blue Cross NC has modeled a rapid shift to value-based care. In a past interview, Von Nguyen, MD, chief medical officer of Blue Cross NC told HealthPayerIntelligence about the three factors that supported this transition.

According to Nguyen, establishing multi-year agreements with providers, building trust between the payer and providers with data exchange, and enabling effective care coordination were the main reasons why Blue Cross NC was able to quickly shift to value-based care.

“At the core of it, the partnership with providers is what makes us successful,” Nguyen said.

“Having been on the provider side, it was frequently ‘us versus them.’ And we want to change that conversation. I would argue that we have very effectively changed that conversation to where, rather than having the provider versus insurance company arguing over money, it’s about providers with insurance companies working together to deliver the best care to our members in a meaningful way.”

Other payers that are part of Blue Cross Blue Shield Association have introduced value-based care models as well. Last July, Blue Cross Blue Shield of Massachusetts (Blue Cross) launched a payment model for small practices that combined value-based care and support payments.

This model supported independent physicians by providing financial stability while also expanding Blue Cross’ previous value-based care model.