Payer Value-Based Care Program Ups Savings, Provider Participation

A value-based care program from Blue Cross and Blue Shield North Carolina (Blue Cross NC) saw cost savings and quality improvement and increased provider participation in its first year, the payer reported.

“The first full year of Blue Premier shows us what’s possible when we change the way we pay for health care,” said Rahul Rajkumar, MD, Blue Cross NC senior vice president and chief medical officer.

“These preliminary results show that Blue Premier providers have stepped up to improve care for Blue Cross NC members and help make North Carolina a leader in the movement to value-based care.”

The payer saved $153 million as a result of these value-based care efforts and distributed $85 million to program provider partners in performance-related payments.

“These performance payments go back to our patients and our clinicians, with re-investments that continuously improve our system of care and support our mission to improve the health and well-being of North Carolinians,” said Mark Gwynne, DO, president of UNC Health Alliance.

Blue Premier’s goal for the first year was to see at least half of its members getting care from a provider who embraced risk in a value-based contract by early 2020. And by 2024, the payer expects all of its members will be receiving care from a provider in a value-based contract.

The payer says it has already surpassed its first goal. Currently, 52 percent of Blue Cross NC members are in value-based care programs. Based on this progress, the payer wants to have over a million members in value-based care models for 2021.

Providers conducted colorectal cancer screenings on over 3,000 more members this year, an advancement that is crucial as risk factors increase among millennials and the threat of coronavirus complications grows. According to Blue Cross NC, this effort could add 800 years of life collectively for Blue Cross NC members.

Furthermore, Blue Cross NC’s provider partners conducted over 13,400 controlled blood pressure readings for members.

In the Blue Premier program, providers have to take financial responsibility for the quality and cost of care. The contracts are long-term. While Blue Cross NC focused on quality improvement in provider first year performance reviews, shared risk and shared cost savings for providers will be more closely considered in future annual performance reviews.

“Blue Premier is one of the most rapid and comprehensive shifts to value-based care in the nation by any health plan,” the press release stated.

The program started at the beginning of 2019 with five of the largest health systems in North Carolina—Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health, and WakeMed Health and Hospitals—as well as various independent physician practices.

Blue Premier took on another three health systems in the first year of its existence— Atrium Health, Novant Health, and FirstHealth of the Carolinas—and other independent providers.

Blue Cross NC is an example of how payers have continued to push for value-based contracting through the coronavirus pandemic.

In late June 2020, the payer announced that it would be financially supporting local independent primary care practices as they moved into a value-based care model.

The program allowed provider partners that joined Blue Premier or Blue Cross NC’s Aledade accountable care organization. Providers then received a monthly fixed payment that was tied to patient outcomes.

“Collaborating with the primary care community has never been more important as this pandemic unfolds. Finding new ways for them to embrace and succeed in value-based care is an important step to better, simpler and more affordable health care for our members,” Tunde Sotunde, MD, Blue Cross NC president and chief executive officer, explained at the time.