Blue Cross NC and five major health systems announce unprecedented move to value-based care

Published 12:00 am Thursday, January 17, 2019

 Blue Premier is one of the most advanced programs in the nation and includes shared risk ‘quality guarantee’ contract between insurer and providers

DURHAM — Blue Cross and Blue Shield of North Carolina (Blue Cross NC), together with five major health systems serving hundreds of thousands of customers, has announced a groundbreaking program to transform health care across the state. Blue Premier is a new value-based model of care in which Blue Cross NC and the health systems will be jointly responsible for better health outcomes, exceptional patient experience and lower costs. With agreements from five of the state’s major health systems and their Accountable Care Organizations (ACOs), Blue Premier is one of the most rapid and comprehensive shifts to value-based payments in the nation.

While health care costs in the U.S. continue to rise, that has not translated into an increase in the quality of care provided to patients. Blue Premier rewards quality of care and bends the cost curve by holding providers financially accountable for higher costs and inefficiencies in the health care system. In the Blue Premier model, inefficiencies turn into an expense rather than revenue for a health system.

“As a practicing physician, I have experienced first-hand the challenges plaguing our health care system,” said Dr. Patrick Conway, Blue Cross NC President and CEO. “Historically, our health care system pays for services that may or may not improve a patient’s health, and our customers simply cannot afford this approach. Moving forward, insurers, doctors and hospitals must work together, and hold each other accountable for improving care and reducing costs. We applaud the leadership and commitment of these five leaders in health care to help transform health care delivery in North Carolina.”

Five major health systems have demonstrated their commitment to transforming health care in North Carolina by agreeing to participate in Blue Premier. Beginning this month, the five health systems joining Blue Cross NC in the Blue Premier effort include:

• Cone Health

• Duke University Health System

• UNC Health Care

• Wake Forest Baptist Health

• WakeMed Health & Hospitals

Blue Premier ties payments to doctors and hospitals over time to the value of services that improve patient health. This means that total payments to the health systems under Blue Premier will be based on the health systems’ ability to manage the total cost of care and their overall performance, measured by industry quality standards. Through a “shared risk” financial model, the health systems will share in cost savings if they meet industry-standard goals to improve the health of patients — and share in the losses if they fall short. The unprecedented commitment from these five large health systems makes Blue Premier one of the most advanced and comprehensive value-based care programs in North Carolina and the nation.

What Blue Premier means for customers

The Blue Premier collaboration between Blue Cross NC and the health systems will help doctors more actively manage a patient’s health care conditions, leading to fewer hospital visits and better health overall. Additionally, patients may have more time and more frequent communication with their doctors.

Within five years, Blue Cross NC has committed to having all customers covered under Blue Premier’s value-based care contracts. By early 2020, 50 percent or more of all Blue Cross NC members will have a provider who is jointly responsible for the quality and total cost of their care.

Blue Premier is just one example of what Blue Cross NC is doing to transform the health care system in North Carolina. Improving primary care access across the state, better integration of behavioral health care and engaging with consumers to give them more tools and resources are additional ways Blue Cross NC is tackling some of the toughest health challenges facing North Carolina. For more information visit the Blue Cross NC blog.

“This unprecedented step by Blue Cross NC and many of the state’s leading health care organizations will make a big difference in advancing high-quality, innovative care in North Carolina,” said Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy. “At Duke-Margolis, we remain committed to supporting state government and private-sector initiatives to reform payment and improve care – providing needed examples for the nation.”