BCBSNC Leading the Shift to Value-Based Care

Blue Cross and Blue Shield of North Carolina (BCBSNC) provides health care products, services and information to more than 3.9 million members, including approximately 1.1 million served on behalf of other Blue Plans.

BCBSNC, in early 2019, introduced its Blue Premier program signaling a shift to value-based care across the state. Blue Premier serves as a model of health care transformation for the nation. It addresses three critical areas plaguing today’s health care system; changing the way we pay for care, putting primary care first, and better integration of mental and behavioral health.  

Duke University Health, UNC Health Care, Cone Health, Wake Forest Baptist Health and WakeMed Health, along with their respective accountable care organizations (ACOs), announced at the time they will adopt the Blue Premier value-based model from BCBSNC.

Blue Premier ties payments to doctors and hospitals over time to the value of services that improve patient health. Healthcare providers will participate in a “shared risk” financial model, requiring them to meet or exceed established quality standards via their ability to manage the total cost of care and their overall performance. They will share in cost savings or share in losses, depending on how well they perform.

Recently, BCBSNC signed new value-based, multi-year agreements with Atrium Health, Novant Health, and FirstHealth of the Carolinas. The systems are joining Blue Cross NC’s Blue Premier value-based program.

FirstHealth of the Carolinas, which operates four acute care hospitals and seven urgent care locations, reaching patients in 15 counties, is the eighth health system to sign on with the program. The agreements put Blue Cross NC on track to meet its goal of having 50 percent of its members served by providers in value-based, shared-risk agreements in 2020.

BCBSNC also launched Blue Premier Behavioral Health to reward behavioral health providers with higher payments for achieving improvements in quality measures. BCBSNC is collaborating with Quartet Health, a health care technology and services company working to improve the lives of people with mental health conditions, to measure the quality of care patients receive and better compensate providers for improving patients’ health.

Takeaway: BCBSNC’s Blue Premier is driving acceptance of a shared-risk financial model for care.