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Blue Cross North Carolina and 5 major health systems enter contract to share in outcomes and costs

The Blue Premier model ties total payments to the health systems' ability to manage costs and overall performance, as measured by industry standards.

Susan Morse, Senior Editor

Blue Cross and Blue Shield of North Carolina has entered into a shared risk contract with five of the state's major health systems and their accountable care organizations.

The program called Blue Premier, ties payment to performance. The health systems share in the cost savings if they meet industry-standard goals to improve the health of patients and reduce costs. The health systems also share in the losses if they fall short.

This commitment makes Blue Premier one of the most advanced and comprehensive value-based care programs in North Carolina and the nation, according to BCBSNC, which is led by President and CEO Dr. Patrick Conway.  Conway is the former director for the Center for Medicare and Medicaid  Innovation.

CMMI developed and implemented models to help transform the industry from fee-for-service to value-based.

The five major participating health systems are Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health and WakeMed Health & Hospitals.

THE IMPACT

While healthcare costs in the U.S. continue to rise, this has not translated into an increase in the quality of care provided to patients, BCBSNC said. Blue Premier holds providers financially accountable for higher costs and inefficiencies, which in turn will cost the health system money.

The Blue Premier collaboration will help doctors more actively manage a patient's healthcare conditions, leading to fewer hospital visits and better health overall. Additionally, patients may have more time and more frequent communication with their doctors, Blue Cross said.

THE TREND

By early 2020, 50 percent or more of all BlueCross BlueShield of North Carolina members will have a provider who is jointly responsible for the quality and total cost of their care, the insurer said.

Within five years, the insurer has committed to having all customers covered under Blue Premier's value-based care contracts. 

ON THE RECORD

"As a practicing physician, I have experienced first-hand the challenges plaguing our healthcare system," Conway said. "Historically, our healthcare system pays for services that may or may not improve a patient's health, and our customers simply cannot afford this approach. Moving forward, insurers, doctors and hospitals must work together, and hold each other accountable for improving care and reducing costs."

"This unprecedented step by Blue Cross NC and many of the state's leading health care organizations will make a big difference in advancing high-quality, innovative care in North Carolina," said Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy. "At Duke-Margolis, we remain committed to supporting state government and private-sector initiatives to reform payment and improve care – providing needed examples for the nation."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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