DURHAM, N.C. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and FirstHealth of the Carolinas, a health care system serving patients in 15 counties in central North Carolina, have signed a new multi-year agreement beginning in 2020 for Blue Cross NC’s Blue Premier value-based care program. The agreement holds the two organizations jointly accountable for better health outcomes, exceptional patient experience and lower costs.
FirstHealth becomes the eighth health system in North Carolina to participate in Blue Premier, adding to one of the most rapid and comprehensive shifts to value-based care in the nation by any health plan. The agreement moves Blue Cross NC closer to its goal of having 50 percent of members served by providers in value-based, shared-risk agreements in 2020.
“Health care systems across North Carolina continue to embrace Blue Premier as the future of value-based care and shared accountability for improving health,” said Rahul Rajkumar, MD, Blue Cross NC chief medical officer. “The addition of FirstHealth of the Carolinas brings the benefits of better value in health care to our members in the Sandhills region and accelerates our efforts to ensure that our members have a provider accountable for the quality and total cost of their care.”
“This agreement with Blue Cross NC reflects the future of quality health care delivery,” said Mickey W. Foster, CEO of FirstHealth of the Carolinas. “The collaboration between health systems and insurers will confirm that patients receive the best care at the lowest cost. FirstHealth embraced the transition from fee-for-service to value-based care many years ago. Our efforts to transform the delivery of health care in our service area aligns with Blue Cross’ efforts to do the same. Blue Cross NC is a great partner, and we look forward to the benefits this new agreement will have for our health system, our patients and the communities that rely on FirstHealth for their health care services.”
How Blue Premier Works
Blue Premier fundamentally changes how health care is paid for by rewarding value rather than the volume of procedures.
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.
When doctors and insurers work together, patients benefit from a better overall experience. 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 providers to share enhanced data so that all parties are on the same page in 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 reduced Affordable Care Act individual premiums by a statewide average of 5.5 percent for 2020 and Medicare Advantage premiums by a statewide average of 31 percent for this year.
The following large health systems in North Carolina are participating in Blue Premier: Atrium Health, Cone Health, Duke University Health System, FirstHealth of the Carolinas, 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) is committed to making health care better, simpler and more affordable since 1933. We have been driving better health in North Carolina for generations, working to tackle our communities’ greatest health challenges. We serve our customers and communities of more than 3.8 million members, including approximately 1.1 million served 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.
About FirstHealth of the Carolinas:
FirstHealth of the Carolinas, a private, not-for-profit health care network, is headquartered in Pinehurst, N.C. Its nearly 5,000 employees serve 15 counties in the mid-Carolinas. Licensed for four hospitals with 610 beds, FirstHealth demonstrates a commitment to treating the whole patient and to providing quality health care for the entire community – especially those in need.