Blue Cross NC unveils “transformative” plan focused on primary care

New health insurance model is built in partnership with practice management provider seeking to implement market-leading data analytics and integrated physician support

DURHAM – Blue Cross NC has announced that “Blue Premier” will be its flagship program within a “value-based care” initiative announced last month. Senior Vice President and Chief Medical Officer, Dr. Rahul Rajkumar, said Blue Premier will be the “signature statewide program for transforming health care in North Carolina…and a model of healthcare transformation for the nation” as it seeks to address three critical areas plaguing today’s health care system: changing how consumers pay for care, putting primary care first and better integration of mental and behavioral health.  

Within the new Blue Premier plan, “health care providers guarantee care standards and collaborate to take a closer look at a patient’s overall health, spending more time with patients who need it the most. With value-based care, doctors and hospitals earn more payments for services when they deliver high-quality care for our members,” said Rajkumar. “But what truly sets Blue Premier apart is that participating systems will share in cost savings if they meet patient health benchmarks – and share in the losses if they fall short” within a newly adopted Accountable Care Organization (ACO) model, he said.

In December, the company launched its partnership with Aledade, a practice management organization specializing in data analytics, practice workflow, and payment systems. Together they announced a new initiative to support hundreds of independently owned and operated primary care physician clinics across North Carolina, with a focus on physician-led ACOs tailored specifically for primary care physicians and the communities they serve. This care model seeks to enable doctors and providers to work as a team to improve the quality of care for their patients, better manage chronic diseases, and ultimately reduce health care costs.

Blue Cross NC says the partnership will work together to provide more resources and encourage data sharing with practices in order to better manage care while improving patient health outcomes. Physicians joining these ACOs can also earn enhanced reimbursement rates and share in a portion of health care cost savings generated from improved quality of care. Officials from both companies have emphasized a commitment to creating opportunities for primary care practices to remain financially independent.

“With health care becoming unaffordable for too many North Carolinians, we must change the way we pay for care to focus on paying for healthier outcomes, not simply for the volume of tests and procedures. Primary care physicians influence a vast majority of health care spending, and their role in this transformation is critical,” said Dr. Patrick Conway, CEO of Blue Cross NC. “We want to provide primary care physicians across North Carolina the tools they need to be best-in-class and succeed in a remodeled health care system built on the foundation of value-based, patient-centered care.”

Through these ACO arrangements, Blue Cross NC will collaborate with Aledade to provide physicians with technology and data analytics tools designed to help make positive changes to a patient’s health care experience. After joining these ACOs, practices ideally gain a more comprehensive view of their patients’ total cost of care, gaps in quality of care, and experiences throughout the entire health care system. For example, physicians will receive notice when their patients visit the hospital or emergency room so they can work with the patient to better manage ongoing health issues. Blue Cross NC points to Aledade’s ACOs around the country which have “proven to improve access to primary care and reduce preventable hospital stays, emergency room visits, and unnecessary services for Medicare beneficiaries as well as commercially insured members.”

The Aledade and Blue Cross NC ACO model is designed to become the preferred value-based care arrangement for independent primary care providers who care for Blue Cross NC’s commercially insured and Medicare Advantage members. Primary care practices under a specialty of internal medicine, family medicine, or general practice for adult care will be eligible to join the ACO model in 2019.

Rajkumar said that Blue Cross NC is committed to ensuring 50 percent of members will have a primary care provider accountable for their care by 2020, and within five years, they hope to have all customers covered under Blue Premier’s value-based care contracts. So far, five major N.C. healthcare providers have committed to participate in Blue Premier: Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health, and WakeMed Health & Hospitals.