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Duke Health and BCBS of North Carolina launch Medicare Advantage company

Duke Health will provide medical services and population health management while Blue Cross NC will handle enrollment, billing and claims.

Blue Cross and Blue Shield of North Carolina and Duke University Health System have teamed up to a launch a new health insurance company aimed at the increasingly popular Medicare Advantage market.

The jointly-owned non-profit company--Experience Health--hopes to roll out a Medicare Advantage plan next year that would be available as an option during the Medicare annual enrollment period starting this fall. Duke Health would be an in-network provider of medical services and population health management programs for Experience Health members, while Blue Cross NC would handle enrollment, billing and claims services.


Medicare Advantage plans are increasingly popular among aging baby boomers--the so-called Silver Tsunami that will impact the healthcare industry for decades to come. Over the last four years, Medicare Advantage enrollment increased by more than 30 percent, while the number of people eligible for Medicare grew by just about 18 percent. That's driving more healthcare firms to pursue the MA opportunity: 27 percent of major U.S. health system executives intend to launch a Medicare Advantage plan in the next four years, according to a survey from last June.

The Duke Health-Blue Cross NC venture is designed to appeal to seniors by encouraging stronger patient-physician relationships through enhanced communication and team-based care, using advanced data and analytics to provide optimal care to patients with health challenges, improving care coordination so patients have clear treatment goals and plans, and simplifying appointments, billing and access to providers.

"Consumers want the best possible health care that's simpler and more focused on their unique needs," said Patrick Conway, MD, president and CEO of Blue Cross NC. "Experience Health will offer exactly that by featuring exceptional Duke Health medical care with efficient Blue Cross NC operations."


Insurer-provider collaborations such as the Blue Cross NC-Duke Health partnership are becoming increasingly commonplace as the healthcare industry moves toward value-based care. By working together and sharing information, insurers and providers hope to improve care and patient health outcomes while simultaneously cutting costs and waste.

In fact, Experience Health is just the latest collaboration between Duke Health and Blue Cross NC. In January, Blue Cross NC and Duke Health (along with four other North Carolina health systems) launched Blue Premier, a value-based care model in which Blue Cross NC and health systems are jointly responsible for health outcomes, cost and customer experience. Participants share in the cost savings if they meet industry-standard goals to improve the health of patients and reduce costs--as well as share in the losses if they fall short.


"Our goal at Duke Health is always to seek innovative ways to lead in the delivery of highest-quality care to our patients, their families and loved ones," said Dr. A. Eugene Washington, Chancellor for Health Affairs, Duke University, and president and CEO, Duke University Health System. "Experience Health represents a one-of-a-kind collaboration between Duke Health and Blue Cross NC to enhance the quality of care, the patient experience, and to bring even greater value to our patients."

Mark Klimek is an independent writer and editor with 20 years' experience covering financial issues, healthcare and more.