September 27, 2021 Update: This communication has been updated to include details on age requirements for eligible members. The original communication was posted on January 22, 2021.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has launched a value-based care program to ensure Blue Cross NC members with kidney disease have access to better, more affordable health care. Blue Premier Advanced Kidney Care, which began Jan. 1, 2021, is the newest feature in the company’s industry-leading Blue Premier value-based care initiative that pays providers for meeting quality and cost standards.

Blue Cross NC is offering Blue Premier Advanced Kidney Care in collaboration with Fresenius Health Partners and Strive Health, two national leaders in bringing the benefits of better-coordinated, high-quality care to patients with kidney disease.

One of the major responsibilities of Fresenius Health Partners and Strive Health is establishing collaborative working relationships with primary care and nephrology practices in the Blue Cross NC network. We are notifying you of this new program so that you are aware prior to these program providers contacting you. We also hope this information will help you have conversations with and answer questions from eligible patients.

Eligible members are automatically included in the program. They include:

• Members who have been diagnosed with stage four or five chronic kidney disease and those diagnosed with end-stage renal disease receiving dialysis services and
  
• Members on fully insured, administrative services only* or Federal Employee Program plans and Medicare Advantage plans offered or administered by Blue Cross NC
  • *Members of State Health Plan, Inter-Plan Program Host and Medicaid plans are currently not included in this program.

Under the program, Blue Cross NC will collaborate with Fresenius and Strive Health to enroll eligible members in the program, which is offered at no additional cost. Providers do not need to do anything to have an eligible patient enrolled. Fresenius and Strive Health will work with primary care physicians and nephrologists in the Blue Cross NC network to identify care gaps and support providers in delivering high-quality, coordinated and patient-centered care — for example, scheduling regular preventive care to ensure that patients don’t miss needed medical encounters. Members may keep their current providers.

Please note: Members under the age of 18 are not eligible for this program.

• Comprehensive member care management and disease education
• Enhanced care coordination among primary care, nephrology and other specialties
• Value-based care payments based on Blue Premier Advanced Kidney Care program provider accountability for total cost of care and quality performance measures (unlike traditional fee-for-service kidney care in which providers are paid on the basis of how many procedures and tests they perform)

Blue Cross NC’s Blue Premier is recognized as one of the most rapid and comprehensive shifts to value-based care in the nation by any health plan. Blue Premier agreements cover multiple years and build toward shared financial risk between Blue Cross NC and providers, which sets the program apart from other value-based care arrangements. When providers and insurers are aligned on their goals, patients see better, simpler and more affordable health care.

Providers in Blue Premier collaborated with Blue Cross NC to generate an estimated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on health care in 2019, the program’s first year.