Independent primary care practices are the foundation of our health care system and play a critical role in providing care to the communities that we serve together.
We recognize that the effects of the COVID-19 pandemic have created a financial crisis for many independent primary care providers in our state. To address this crisis, we are launching a program called Accelerate to Value to support independent primary care practices.
Welcome to the Accelerate to Value Program for Independent Primary Care.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has created the Accelerate to Value Program for Independent Primary Care1 to support independent primary care practices by offering financial stability during this time and a pathway towards participation in the Blue Cross value-based accountable care organization (ACO) program called Blue Premier. Have questions? Check out our FAQ.
The Accelerate to Value Program for Independent Primary Care is a two-year program with three goals:
To provide financial stability to independent primary care practices to deliver high value care, including access to quality clinical care for Blue Cross NC members during the COVID-19 pandemic.
Should your practice participate in the Accelerate to Value program, you will receive supplemental payments to stabilize your Blue Cross NC revenue at its pre-COVID-19 level. Our hope is that these payments will enable you to continue serving your patients and ensure access to high-quality clinical care for Blue Cross NC members during the COVID-19 pandemic.
Here’s how it works:
- We will calculate the payments all eligible practices received in 2019 for core primary care services provided to Blue Cross NC members.
- We will then assess the difference between those payments (pre-COVID) and 2020 year-to-date payments (post-COVID), among eligible practices.
- You’ll receive a per-attributed-member-per-month (PAMPM) payment for each member attributed to your practice based on the difference between our pre-COVID and post-COVID spending calculations.
The design of the program is to “true up” your practice revenue for core primary care services in 2020 and 2021 to what an average practice would have earned in 2019. We will calculate and make “catch-up payments,” if necessary. This enables us to make course corrections along the way and adjust payments in order to keep total revenue for practices in the program at 2019 levels. This is a two-year program with payments scheduled to start in August 2020 and continue through 2021 for all participating practices that meet the program requirements described below.
We ask practices to commit that you will provide access to care for our members. This means pledging to remain open, promote the use of telehealth, and provide care coordination and care delivery activities responsive to the COVID-19 pandemic. These attestations are subject to audit by Blue Cross NC, but we will not include a formal measurement or reporting process.
To provide a bridge to participate in Blue Cross NC’s value-based care program called Blue Premier while staying independently owned.
We ask practices to move toward shared accountability for quality and total cost of care by joining a Blue Premier accountable care organization (ACO) for all segments of our membership by December 31, 2020. Blue Premier is a program that allows primary care providers to earn shared savings payments by reducing the total cost of care and improving quality of care for the patients you serve. Independent practices that are already part of the Blue Premier program do not need to do anything further to meet this requirement. If your practice is not part of a Blue Premier ACO by December 31, 2020, you will be removed from the Accelerate to Value program.
To provide predictable and firm support to aid your response to COVID-19 and your work to serve communities across North Carolina.
Independent primary care practices have shown to be instrumental in improving outcomes, quality, and patient experience for Blue Cross NC members. Beyond the COVID-19 pandemic, we want to forge the path toward a sustainable future for independent primary care practices by fully accessing value-based contracting opportunities like Blue Premier. And we want to preserve the critical role you play in the fabric of North Carolina.
You will have the option to join Blue Premier through Aledade—a company that partners with Blue Cross NC to help independent physician practices transition to value-based models—or through the Clinically Integrated Network (CIN) of an existing Blue Premier ACO. Our team will provide more details about this during our webinar series, including opportunities to meet with Aledade and other eligible Blue Premier ACOs. All options will enable you to remain independent.
We are also excited to announce our plans to offer a model for primary care provider (PCP) capitation starting in 2022 to practices in the Accelerate to Value program. PCP capitation is a fixed payment for a basket of core primary care services paid on behalf of all Blue Cross NC members attributed to you. We are not asking you to make a binding commitment to accept PCP capitation at this time. However, we believe this will be an attractive payment model that will offer sustainable funding for primary care services.
- Your practice is an independently owned and operated primary care practice, including internal medicine, family medicine, pediatrics, geriatrics, multispecialty, and/or OB-GYN. Practices owned by hospitals and health systems are not eligible.
- The providers in your practice are in-network and otherwise in good standing with Blue Cross NC.
- Your practice is able to receive payments via electronic funds transfer into the bank account on record with Blue Cross NC.
Statements to Pledge To:
- Clinical quality for our members, including ensuring access to care for members, promoting telehealth adoption, using electronic health records, and providing care coordination and care delivery activities responsive to the COVID-19 outbreak, such as the continued delivery of preventative care and support for transitions of care.
- Moving towards shared accountability for quality and total cost of care by joining an accountable care organization (ACO) in the Blue PremierTM program by Dec. 31, 2020.*
*Practices already part of the Blue Premier program are eligible and can apply below.
Independent primary care practices in North Carolina who are currently partners with Aledade are eligible to apply. The Accelerate to Value program is in addition to and separate from the Blue Cross NC Independent Primary Care Provider Assistance Program. Practices who are already participating in this program will continue to do so as stipulated.
If you have been involved in a negotiation with Blue Cross NC over the past 12 months, please contact your Contract Manager for additional details.
Applications are now open. To begin the application, click on the link below. Have questions? Check out our FAQ.
When you have submitted your application, the Blue Cross NC team will notify you of your selection to participate in the program. Blue Cross NC will estimate total payment and the payment schedule. You will need to execute a contract addendum with Blue Cross NC to officially participate in the program.
Blue Cross NC will host a special set of “Virtual Rounds” during the following dates/times to review specifics of the program and answer your questions. The first webinars are scheduled for:
- Monday, June 29, 2020 from noon - 1:00 pm ET (View the presentation here.)
- Friday, July 10, 2020 from noon - 1:00 pm ET
- Friday, July 24, 2020 from noon - 1:00 pm ET
To register for the Accelerate to Value Virtual Rounds sessions, please click here.
(Note: These are separate sessions from the regular COVID-19 Virtual Rounds we’ve been hosting. If you would like to attend the Accelerate to Value Program Virtual Rounds, you must complete this registration form.) We will share slides from these sessions and an updated FAQ to participants who have signed up for the event.
We strongly encourage your attendance at the Virtual Rounds sessions as our team will provide an overview of the program and you will be able to have your questions answered. You can also send inquiries to AcceleratePCP@bcbsnc.com.