DURHAM, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC), advancing its efforts to transform health care, has signed new value-based, multi-year agreements with Atrium Health and Novant Health – two of North Carolina’s largest health systems. Both systems are joining Blue Cross NC’s Blue Premier value-based program, a contractual arrangement that holds the systems and Blue Cross NC jointly accountable for better health outcomes, exceptional patient experience and lower costs.
The addition of Atrium Health and Novant Health means that seven of the state’s largest health systems are participating in Blue Premier beginning in 2020. The agreements put Blue Cross NC on track to meet its goal of having 50 percent of its members served by providers in value-based, shared-risk agreements in 2020. This unprecedented level of commitment from seven large health systems establishes Blue Premier as the most rapid and comprehensive shift to value-based payment in the nation by any health plan.
“In 18 months, we have made tremendous progress toward making North Carolina a national leader in transforming health care, working collaboratively with hospitals and physicians,” said Rahul Rajkumar, MD, Blue Cross NC chief medical officer. “Atrium Health, Novant Health and Blue Cross NC share a commitment to rewarding the things that matter to patients: higher-quality, better-coordinated care and lower cost. We applaud the seven systems now in Blue Premier and look forward to having others join us in changing health care.”
“With over 14 million patient interactions each year, we know the communities we are privileged to serve are counting on Atrium Health to fulfill our mission to improve health, elevate hope and advance healing – for all,” said Rasu Shrestha, MD, EVP and chief strategy officer for Atrium Health. “This unique value-based agreement with Blue Cross NC and Atrium Health is a great example of the innovative collaboration that can happen between care providers and insurers to make care more affordable, while also increasing the quality of the care that is provided.”
“At Novant Health, we have thoughtfully approached the navigation from fee-for-service to value-based care for years,” said Pam Oliver, MD, EVP and President of Novant Health’s Physician Network. “We believe this joint accountability model enhances quality, cost, and patient experience as a foundation for care, which closely aligns with our mission to improve the health of our communities, one person at a time.”
How Blue Premier Works
Blue Premier is an example of value-based care. It differs from traditional fee-for-service, in which the provider is paid based on the volume of procedures, regardless of efficiency or health outcomes.
Blue Premier goes a step beyond most value-based care efforts that simply reward providers for meeting performance standards. It’s a unique model of care with hospitals, physicians and Blue Cross NC working together to improve outcomes and reduce costs. Through a “shared risk” financial model, a Blue Premier health system shares in cost savings if it meets goals to improve the health of patients – and shares in the losses if it falls short of targets established by the model.
The Blue Premier collaboration helps doctors and health systems more actively manage a patient’s health care conditions and helps Blue Cross NC learn more about its members, leading to fewer hospital visits and better health overall. The agreement also establishes ways for Blue Cross NC and the provider to share enhanced data, so that all parties are on the same page when it comes to ensuring high standards of care. Blue Cross NC projects that because of the new payment model, Blue Premier will result in medical cost savings of 15 percent over 10 years.
Shifting payments to value-based contracts with downside risk is one of several factors in Blue Cross NC’s recent progress on lowering health care costs. The company is reducing Affordable Care Act individual premiums by a statewide average of 5.5 percent in 2020 and Medicare Advantage premiums by a statewide average of 31 percent in 2020.
The following large health systems in North Carolina are participating in Blue Premier: Atrium Health, Cone Health, Duke University Health System, Novant Health, UNC Health Care, Wake Forest Baptist Health, and WakeMed Health & Hospitals.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.9 million members, including approximately 1.1 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. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit Blue Cross NC online at bluecrossnc.com. All other marks are the property of their respective owners.