DURHAM, N.C., and BETHESDA, Md. – Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Aledade today announced that their collaboration on North Carolina physician-led Accountable Care Organizations (ACOs) helped nearly 50 primary care practices across the state lower costs and improve quality in the first year of operation.
Results from the ACOs show that the 47 primary care practices that participated:
• Reduced total cost of care by 4.7 percent for commercial patients
• Reduced total cost of care by 6.1 percent for Medicare Advantage patients
• Improved the quality of care for their almost 55,000 patients
• Collectively earned $10.5 million in incentive payments
• Improved their Medicare star ratings, on average, from 3 stars to 4.5 stars
“Independent primary care practices are vital to helping the nation recover from COVID-19, and our partner practices in North Carolina are demonstrating how the transition to value-based care supports that effort,” said Annette DuBard, MD, MPH, executive director of the Aledade North Carolina ACO. “Aledade looks forward to continuing to work with our current physician partners and to expanding our ACO to deliver more people the best possible care, while improving health outcomes and controlling unnecessary costs.”
The participating ACOs’ incentive earnings of $10.5 million has proven to be a crucial financial lifeline to primary care physicians on the front lines of the COVID-19 pandemic. ACOs are groups of providers that share financial responsibility for delivering high-quality, better-coordinated patient care.
“Aledade and Blue Cross NC are strong collaborators in helping advance value-based care,” said Rahul Rajkumar, MD, Blue Cross NC senior vice president and chief medical officer. “These results show that physician practices in the ACO program are among the top-performing providers in delivering high-quality, cost-effective care to North Carolinians.”
Shifting to value-based payments is one of several factors in Blue Cross NC’s recent progress on lowering health care costs, including lower Affordable Care Act and Medicare Advantage premiums for 2020. In addition to lowering the total costs of care, the practices participating in the North Carolina ACOs achieved significant improvements in the quality of care and health outcomes. These gains were reflected in improved Medicare Advantage star ratings. For example:
• From April 2019 to the end of the year, the practices improved their star rating from 3 stars to 4.5, through improved care for patients with chronic conditions like hypertension and diabetes, helping more patients receive cancer screening, and supporting patients after discharge from a hospital stay.
• Specifically, practices in the ACOs improved Medicare Advantage star ratings by at least one star in seven categories:
o Medication adherence for patients with hypertension
o Medication reconciliation post-discharge
o A1C control ≤ 9.0 for patients with diabetes
o Adult obesity assessment
o Attention to nephropathy for patients with diabetes
o Colorectal cancer screening
o Recommended therapy for patients with Rheumatoid arthritis
“Blue Cross NC continues to lead the nation in the movement to value-based care models,” said Farzad Mostashari, CEO of Aledade. “It is an honor to work with them to serve the outstanding primary care professionals in our ACO as we usher in a new era for primary care, improve care delivery, and lower costs for the people of North Carolina."
“The Blue Cross NC and Aledade performance defines true value-based care, setting the stage for quality, efficient, and accessible care for patients in our communities,” said Dr. Karen Smith, a primary care physician in Raeford, N.C., and member of the North Carolina ACO. “I’m so thankful to Aledade and Blue Cross NC for believing in the power of primary care.”
Aledade’s work with Blue Cross NC enables doctors, providers and Blue Cross NC to work as a team to improve the quality of care for patients, better manage chronic diseases, and ultimately reduce health care costs. With necessary claims data and support from Blue Cross NC, Aledade provides participating physicians with a full range of capabilities that include cutting-edge data analytics, user-friendly care management and patient outreach tools, regulatory expertise, and hands-on support from local experts in practice transformation.
Physicians joining these ACOs may also earn enhanced reimbursement rates and share in a portion of health care cost savings generated from improved quality of care. The joint effort demonstrates both groups’ commitment to creating opportunities for primary care practices to remain financially independent.
In addition, Aledade is supporting Blue Cross NC’s Accelerate to Value financial support program for primary care. The program, announced in June, offers a path to value-based care for independent primary care practices, which have suffered from loss of revenue during the COVID-19 pandemic. Practices may join an Aledade ACO to gain the benefits of Accelerate to Value.
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.
Founded in 2014, Aledade partners with independent practices, health centers, and clinics to build and lead Accountable Care Organizations (ACOs) anchored in primary care. Through these ACOs, Aledade empowers physicians to stay independent, practice medicine like they’ve always wanted to, and thrive financially by keeping people healthy. Aledade offers a comprehensive range of capabilities that includes cutting-edge data analytics, user-friendly guided workflows, unparalleled regulatory expertise, strong payer relationships, and local, hands-on support from attentive experts. In true alignment with more than 7,300 participating providers in 27 states, Aledade shares in the risk and reward across more than 80 value-based public payer and commercial contracts representing more than 840,000 lives under management. To learn more, www.aledade.com or follow on Twitter or Facebook.