The next level of value-based care

Published January 22, 2019

One of the biggest drivers of the nation’s $3.3 trillion dollars in healthcare spending, according to the Centers for Disease Control and Prevention, is medical care for patients with chronic diseases and mental health conditions. Helping patients manage those conditions before they worsen is one of the promises of value-based care. Blue Cross and Blue Shield (BCBS) companies have partnered with doctors and hospitals across the country to drive innovative value-based care programs that pay for quality outcomes rather than the volume of services. To-date, some 62 million BCBS members have access to these programs.

This week, Blue Cross Blue Shield of North Carolina (BCBS North Carolina) unveiled a program called Blue Premier that takes value-based care to the next level. The company is collaborating with five major health systems in North Carolina that together cover hundreds of thousands of the state’s residents – Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health and WakeMed Health & Hospitals.

Similar efforts among Blue Cross and Blue Shield companies are already improving patient health and delivering cost savings for patients and employers. BCBS North Carolina’s initiative builds on these efforts by not only striking agreements with such a broad swath of health systems, but also launching shared-risk contracts with each of them that hold providers accountable for the total cost and quality of care.

“Historically, our healthcare system pays for services that may or may not improve a patient’s health,” said Dr. Patrick Conway, president and CEO of BCBS North Carolina. “Moving forward, insurers, doctors and hospitals must work together, and hold each other accountable for improving care and reducing costs.”

Dr. Patrick Conway, president and CEO of BCBS North Carolina, announces Blue Premier, a new value-based care plan.

The health systems and BCBS North Carolina will share responsibility for better health outcomes, exceptional patient experience and lower costs. 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. For doctors, this approach provides an even stronger incentive to more actively manage a patient’s chronic conditions, with a goal of fewer hospital visits and improved overall health. For patients, it makes it possible to have more time and more frequent communication with doctors. 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.

Moving from a volume-based, fee-for-service model where healthcare systems were compensated for patient counts and turnover to a value-based model that rewards quality of care, Blue Premier will hold providers financially accountable for higher costs and inefficiencies. “The elegant thing in all of this is that the right thing to do for patients is also far and away the most cost-effective thing to do for patients,” says Terry Akin, CEO, Cone Health. “Actually moving away from a model of care that incentivizes and rewards us for activity to a model that incentivizes and rewards us to partner with people in the community and keep them well and healthy and out of the hospital is kind of a radical thought but one that we’ve been committed to for quite a while.”

Media and attendees listen as Dr. Patrick Conway, president and CEO of BCBS North Carolina, details a new value-based care plan set to take North Carolina healthcare to the next level.

BCBS North Carolina is setting aggressive goals for the Blue Premier program, aiming to have more than 50 percent of members covered under Blue Premier’s value-based partnerships within the next year – and 100 percent within five years.

Conway believes the new program could be a model for the nation of what’s possible. “This new agreement sets the stage for transforming healthcare in North Carolina,” he says. “It gives doctors and hospitals more freedom to do what they do best – care for patients.”

Learn how BCBS North Carolina and other BCBS companies are working to improve diversity in clinical trials and advance precision medicine.

Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.