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Blue Premier: Redefining what is possible in health care

Health care is evolving at a rapid pace and we recognize that this can leave North Carolinians with tough choices to make.

For 85 years, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has remained committed to advocating for our customers on issues of health care costs and access to care. Better health care requires new and innovative solutions that will help lower costs, and we are here to help. But, what do these solutions look like?

We’re excited to introduce Blue Premier, our signature statewide program for transforming health care in North Carolina. Blue Premier serves as a model of health care transformation for the nation. It tackles three critical areas plaguing today’s health care system; changing how we pay for care, putting primary care first and better integration of mental and behavioral health.

Changing how we pay for care

How we pay for care matters because it signals what we value the most: quality, health outcomes and patient experience. We are dedicating significant resources to establish one of the most advanced value-based care initiatives in the nation, working together with providers to help simplify and improve the health system for members in all 100 North Carolina counties. Paying for value means no longer paying for health care based only on the quantity of visits, tests or procedures; it means paying for results and for demonstrating high-quality care.

Under Blue Premier, 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.

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.

Putting primary care first

Revising contracts with doctors and hospitals alone won’t fix the problems across our health system. Another way to improve the health of our customers is to put a greater focus on primary care. Primary care physicians are the backbone of our health care system and they should be the first point of contact for patients with chronic conditions. Putting primary care first sets the foundation for a health care system that pays providers for care based on the outcomes and the quality of care. It enables doctors and providers to work as a team to improve the quality of care and outcomes for their patients, and ultimately reduce health care costs.

We’re collaborating with Aledade to support hundreds of independently owned and operated primary care physician clinics across North Carolina. Together we will support physician-led Accountable Care Organizations (ACOs) tailored specifically for these primary care physicians and the communities they serve.

Through ACO arrangements, we will provide physicians with easy-to-use technology and data analytics tools that help make positive changes to a patient’s care experience. These primary care practices will gain a more comprehensive view of their patients’ total cost of care, gaps in care and their experiences throughout the entire health care system.

Physicians joining in these ACOs can also earn enhanced reimbursement rates and share in a portion of health care cost savings generated from improved quality of care – which can also help primary care practices remain financially independent.

Better integration of mental and behavioral health

Most of behavioral health treatment is already provided in primary care and often without access to specialists. As part of our efforts to transform health care, we’re working to better integrate behavioral and mental health into primary care for more holistic, patient-centered care.

These investments will support Blue Premier providers in offering the best solutions to all their patients. Better integration of primary care and behavioral health services can improve outcomes and prevent costly ER visits.

Bottom line, the goal is for providers and insurers to work together to view a preventable hospital readmission as an expense, rather than a source of revenue. This means doing our part to remove red tape where possible, like prior authorizations in certain situations, so doctors can concentrate on delivering high-quality care, not paperwork.

Working together

We are committed to ensuring 50 percent of our members will have a primary care provider accountable for their care by 2020 through this innovative program. Within five years, Blue Cross NC has committed to having all customers covered under Blue Premier’s value-based care contracts. Today, we are proud to announce the following systems and their ACOs have joined us in this journey of transforming our health system through Blue Premier: Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health and WakeMed Health & Hospitals.

authors photo

Rahul Rajkumar, MD

Rahul Rajkumar, MD

Rahul worked as senior vice president and chief medical officer at Blue Cross NC until 2020.

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