DURHAM, N.C. – Health care providers in the Blue Premier value-based care program collaborated with Blue Cross and Blue Shield of North Carolina (Blue Cross NC) to generate an estimated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on health care in the program’s first year. These results demonstrate progress toward making health care better and more affordable through greater collaboration between providers and insurers.
Blue Cross NC recently calculated first-year results from the five major health systems that joined Blue Premier at its launch in January 2019. Blue Premier also includes independent physician practices across the state participating through four accountable care organizations (ACOs) powered by a collaboration with Aledade. Collectively, the systems and practices met their performance goals for delivering high-quality, cost-effective care for the 536,000 Blue Cross NC members they served last year.
For example, they collectively increased screenings for colorectal cancer by an additional 3,041 members and controlled blood pressure for 13,412 more members than in 2018. These efforts likely averted many heart attacks, strokes and deaths. Using estimates from the U.S. Preventive Services Task Force, the enhanced efforts in colorectal cancer screening alone could result in more than 800 additional years of life for Blue Cross NC members.1
As a result of these improvements, Blue Cross NC has made performance payments totaling $85 million to Blue Premier providers.
“Blue Premier health systems and physician practices are leading the way to higher quality, more affordable health care in North Carolina and setting the pace nationally,” said Tunde Sotunde, MD, Blue Cross NC President and CEO. “Our members benefit from a better overall health care experience when their health plan and their doctors and hospitals work together to improve quality and reduce costs.”
Blue Premier Doctors and Hospitals
Providers in Blue Premier since the program’s inception include:
• Cone Health and affiliated physician practices (Triad HealthCare Network)
• Duke University Health System and Duke Private Diagnostic Clinic
• UNC Health and affiliated practices (UNC Health Alliance)
• Wake Forest Baptist Health
• WakeMed Key Community Care (WKCC) including WakeMed Hospitals
• Independently owned primary care practices in ACOs affiliated with Aledade, a primary care company with an agreement with Blue Cross NC
“Success in value-based care requires focus and the right investments in our providers, care teams and population health. We have a relentless drive to transform our health care system to deliver the highest quality outcomes while making care more affordable for our patients,” said Dr. Mark Gwynne, president of UNC Health Alliance. “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. Partnerships like Blue Premier align directly with that mission.”
Since its inception, Blue Premier has added three more health systems – Atrium Health, Novant Health and FirstHealth of the Carolinas – and more independent primary care practices. Blue Cross NC now attributes 52 percent of its eligible membership to a provider with a value-based care agreement – surpassing the company’s goal of reaching 50 percent in 2020. In 2021, the company expects to have more than 1 million members receiving care from primary care providers in value agreements.
Blue Premier is one of the most rapid and comprehensive shifts to value-based care in the nation by any health plan. It holds participating providers and Blue Cross NC jointly accountable for meeting quality and cost measures. Under value-based care, provider pay is based on quality of care, not on the quantity of procedures, tests and appointments performed.
Blue Premier agreements cover multiple years and build toward shared financial risk between Blue Cross NC and providers, which sets Blue Premier apart from other value-based care arrangements.
“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.”
Blue Cross NC analyzed Blue Premier first-year performance to determine how much to share with providers for meeting cost and quality targets. Under the terms of Blue Premier agreements, these performance payments during the first year were intended to reward quality improvements, while payments in future years will depend increasingly on shared cost savings and shared risk.
Blue Premier providers are using their performance payments to continue improving care, reducing costs and meeting financial challenges related to the COVID-19 pandemic. Savings realized by Blue Cross NC are used to keep health care as affordable as possible. Blue Cross NC made its Blue Premier payments ahead of schedule to providers in light of financial burdens caused by the pandemic.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to making health care better, simpler and more affordable. We have been driving better health in North Carolina since 1933, working to tackle our communities’ greatest health challenges. Blue Cross NC serves its customers and communities of more than 3.8 million members, including approximately 1.1 million on behalf of other Blue Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. Visit Blue Cross NC online at www.bluecrossnc.com. All other marks are the property of their respective owners.
1U.S. Preventive Services Task Force; NNT Group