CHAPEL HILL, N.C. — Blue Cross and Blue Shield of North Carolina (BCBSNC) customers may now take advantage of a new bundled payment program for total knee replacement surgeries through an arrangement with Novant Health. Under the new agreement, BCBSNC customers will pay a single price for initial knee replacement surgeries and benefit from Novant Health’s coordinated care approach. Overall, participating BCBSNC customers are expected to save 10 to 30 percent on the cost of knee replacement.1
The providers participating in the new agreement include:
- Novant Health Presbyterian Medical Center
- Novant Health Huntersville Medical Center
- Bryan Edwards, MD and Jess Kirby, MD with Novant Health Orthopedics and Sports Medicine
- Howard Homesley, MD with Barron and Homesley Orthopedics Specialists
Bundled payment agreements allow doctors and hospitals to work collaboratively to deliver higher quality, evidence-based care to reduce complications and readmissions, according to studies by the Centers for Medicare and Medicaid Services.2
“The bundled payment model moves us away from the traditional ‘fee-for-service’ model where the patient pays medical professionals for each service they provide patients, including tests, appointments and procedures,” said Brad Wilson, BCBSNC president and CEO. “With bundled payment agreements, like this one, patients pay one bill, even if they have to come back for another procedure or follow-up visit.”
With this new agreement, BCBSNC customers, including State Health Plan members, between the ages of 19 and 64 will benefit from Novant Health’s care management approach that delivers a coordinated patient experience across the full episode. Novant Health care management team will follow the patient from procedure to discharge to recovery, reflecting the way patients experience and recover from a medical procedure like knee replacement.
The agreement includes:
- All services associated with the surgery (except anesthesia), including post-surgical care, follow-up appointments and physical therapy for up to 90 days after the surgery
- Personalized care coordination from Novant Health’s team of care managers.
“Novant Health is committed to providing valuable, quality care to our patients,” said Derek Goldin, Novant Health vice president in business development and sales. “These types of arrangements help patients understand their out-of-pocket expense for care by removing layers of complexity and we will continue to find opportunities to simplify and enhance the quality of healthcare we deliver to our patients.”
Last year, approximately 1,000 BCBSNC customers benefited from similar bundled knee payment agreements. On average, BCBSNC customers saw:
- Cost savings of 10 to 30 percent for knee replacement surgeries
- Outcomes better than national benchmarks
- A reduction in complications as compared to other total knee replacements performed in North Carolina
- Very high patient satisfaction with the care team
BCBSNC customers who are interested in taking advantage of this new model can contact one of the physicians listed above.
*BCBSNC customers under FEP and Blue MedicareSM do not qualify for this payment model.
¹ BCBSNC Internal Data, 2014
Blue Cross and Blue Shield of North Carolina improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.91 million members, including approximately 1 million served on behalf of other Blue Plans. Since 1933, we have worked to make North Carolina a better place to live through our support of community organizations, programs and events that promote good health. We have been recognized as one of the World’s Most Ethical Companies by Ethisphere Institute every year since 2012. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com. All other marks are the property of their respective owners.
About Novant Health
Novant Health is a four-state integrated network of physician clinics, outpatient centers and hospitals that delivers a seamless and convenient healthcare experience to our communities. Novant Health consists of more than 1,200 physicians and 26,000 employees who make healthcare remarkable at nearly 500 locations, including 14 medical centers and hundreds of outpatient facilities and physician clinics. Headquartered in Winston-Salem, N.C., Novant Health is committed to making healthcare remarkable for patients and communities, serving more than four million patients annually. In 2014, Novant Health provided more than $639 million in community benefit including charity care and services. Novant Health is an IMS Health top 20 integrated delivery network in the nation.