BCBS Introduces Value-Based, Patient-Centered Kidney Care Model

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has introduced a value-based care program that focuses on improving health outcomes for members with kidney disease through coordinated and patient-centered care.

The initiative, launched on January 1, is the newest feature in the industry-leading Blue Premier value-based care model. Eligible Blue Cross NC members can enroll in the Blue Premier Advanced Kidney Care program at no additional cost.

Blue Cross NC is offering the program in collaboration with Fresenius Medical Care North America (FMCNA) and Strive Health, two national leaders in providing quality care to patients with kidney disease.

“It’s important that we help our members with chronic conditions receive coordinated care, delay or prevent the need for dialysis, and improve their quality of life,” said Von Nguyen, MD, Blue Cross NC chief medical officer. “Advanced kidney disease has long been challenging to treat. Working with FMCNA and Strive Health, Blue Cross NC is bringing an advanced level of care to help our members who need it most.”

FMCNA and Strive Health will work with primary care physicians, nephrologists, and other specialists in the Blue Cross NC network to support coordinated and patient-centered care for members with kidney disease.  

Blue Premier Advanced Kidney Care promotes comprehensive care management, including preventative care and disease education, to improve patient health outcomes.

Blue NC will pay providers for the total cost of care and quality performance measures under the value-based care model, unlike traditional fee-for-service kidney care in which providers are paid based on the quantity of procedures and tests they perform.

Members on a commercial or Medicare Advantage plan who have chronic kidney disease stage 4 or 5 or end-stage renal disease (ESRD) are eligible for the program. Members are also able to keep their current providers.

“Kidney disease is complex, and it disproportionately impacts certain patient populations,” said Chris Riopelle, CEO of Strive Health. “Through transformative, value-based kidney care, Strive Health addresses patient care in a way that will help Blue Cross NC improve members’ lives while controlling long-term health care costs.”

“We are pleased to have been chosen by Blue Cross NC to deliver the Blue Premier Advanced Kidney Care program,” said David Pollack, president of Fresenius Health Partners, the value-based care services division of FMCNA. “Our team will deploy proven care coordination systems and services to improve the lives of patients living with kidney disease.”

Strive Health serves 85 counties across the state and FMCNA covers the other 15 counties in the Charlotte and Wilmington areas.

Blue Cross NC’s Blue Premier program achieved 52 percent membership in value-based care arrangements by mid-December 2020 after it was launched in early 2019.

Nguyen pointed to the payer’s partnerships with providers to explain the rapid shift in care delivery.

“The thing that's made North Carolina unique and actually gotten us to a place where we can move quickly is the partnership with providers,” Nguyen told HealthPayerIntelligence in a 2020 interview. “We have strong partnerships with many of the provider systems in North Carolina.”

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

The payer’s goal is to have all of its members in Blue Premier value-based contracts by 2024.