For more than a decade, Blue Cross NC has been a leader in the move to value within health care. In January 2019, we launched Blue Premier, our groundbreaking value-based care program, to take this approach farther—and faster.
Value-based care is spreading across North Carolina. See how it’s making a difference for patients and providers and how Blue Cross NC is making health care better, simpler and more affordable.
The way we work with providers to pay for care matters because it signals what we all value most: quality, affordability and the patient experience. Historically, health care is paid for based on basic statistics – the number of patients seen, the various tests administered and the volume of procedures performed. This is called a fee-for-service model.
Value-based care turns this equation on its head. Instead of paying for the number of services provided, we pay for how well they work – or the value. Paying for value means paying providers based on high-quality, cost-effective care that demonstrates results based on the health outcomes of their patients.
One of the hallmark features of value-based care is that providers are paid based on quality. This helps providers focus on improving the health of their patients, rather than simply performing more procedures.
A primary care physician acts as the health care quarterback, taking into account a member’s physical and mental health and leading the team that coordinates their comprehensive care.
By giving primary care physicians more data, including analytics on how well their practices are doing against clinically accepted quality benchmarks, they can intervene in patient health issues earlier and work with a coordinated team to help patients adhere to their treatments. These efforts can then reduce hospitalizations and preventable ER visits to create a healthier population.
One of the most rapid and comprehensive shifts to value-based payments in the nation
In January 2019, Blue Cross NC launched Blue Premier to change the way we pay for care. Today, this program has been embraced by major parts of our state's health care industry, including 11 health systems, almost 900 primary care practices, and specialists in kidney care and behavioral health.
Transforms care to prioritize health outcomes.
Establishes shared savings between providers and Blue Cross NC and build stoward two-sided risk, holding providers financially accountable for patient outcomes.
Encompasses the full spectrum of care, including primary care accountable care organizations (ACOs) and additional specialty care programs over time.
Integrates physical health and behavioral health and empowers primary care providers to be the hub of patient care.
Shared-risk agreements reward providers for better quality and greater cost savings and introduce penalties when goals are not met. Many Blue Premier providers will begin phasing in shared risk next year.
Maintaining high quality care likely averted many heart attacks, strokes and deaths. For example, in 2020 Blue Premier providers screened an additional 9,546 members for colorectal cancer. Using estimates from the U.S. Preventive Services Task Force,1 the enhanced efforts in colorectal cancer screening alone could result in more than 200 averted deaths and 2,500 additional years of life for Blue Cross NC members. That's what paying for value is all about.
The Blue Premier model is collaborative. Providers across North Carolina have embraced the program because they share our urgency for change and health care transformation. Providers offered input to these models to ensure we are working together to emphasize what's most important: outcomes, affordability, accessibility and equity.
Together, primary care and specialty care programs improve quality and reduce costs. Blue Premier now includes both.
Primary care physicians are in the best position to coordinate patients’ entire care team, ensuring they get access to the right care at the right time—leading to better health and lower costs. That’s why we’ve put primary care at the center of value transformation.
Strengthening North Carolina’s primary care system is central to Blue Premier. Through arrangements with primary care Accountable Care Organizations (ACOs), we’re enabling primary care practices to take a comprehensive view of a patient’s health so they can improve the quality of care and outcomes for their patients, and ultimately reduce health care costs. To date, 870 independent primary care practices have joined Blue Premier, and we’re committed to expanding that number as we move forward.
Blue Premier has added two specialty care programs that align with primary care programs and tie provider payments to value:
Behavioral Health: Introducing innovation into behavioral health care in North Carolina by integrating behavioral health and physical health care, optimizing the behavioral health network and pursuing best-in-class solutions for treatment of substance use disorders.
Kidney Care: Providing comprehensive member care management and enhancing care coordination among primary care, nephrology and other specialties to improve health quality and outcomes for members who have advanced kidney disease.
Generated an estimated $197 million in cost savings, quality improvements and a slowdown in the rate of spending on health care in 2020, on top of $153 million in 2019.
Encompassed 65% of Blue Cross NC’s total annual medical expense.
Delivered high-quality, cost-effective care for the 856,650 Blue Cross NC members served last year.
Blue Premier continues to grow, as more doctors and hospitals within North Carolina see what this program can do for their patients and the overall cost of care. Read the latest about how we’re transforming health care in our state.