Better health care for North Carolina: Lower Prices and Higher Quality, from the Blue Ridge to the Beaches

Changing the Standard of How Americans Pay for Care

Another reason health care costs have risen so quickly and consistently is because the old way of paying for care prioritized the wrong thing: an outdated payment model has rewarded doctors and hospitals for the number of procedures they performed.

At Blue Cross NC, we’re doing things differently, focusing instead on paying for the quality, not the quantity, of care. Our industry-leading value-based care program, Blue Premier, is at the heart of our efforts to make health care more affordable for all North Carolinians.

Under value-based care, providers and insurers work together to set goals to help patients receive better, more affordable, more coordinated care. Blue Premier takes these goals a step further by building toward shared financial risk. These shared-risk agreements reward providers for delivering better quality and greater cost savings to their patients. Doctors, hospitals and insurers all work together to deliver high quality health care in the most affordable way possible. Blue Premier includes a dozen North Carolina health systems and almost 900 independent physician practices.

In 2020, Blue Premier generated $197 million in cost savings. 11 In 2019, savings amounted to $153 million. 12 That’s a pretty remarkable accomplishment; in its first two years, Blue Premier saved our members $350 million.

These savings weren’t created by cutting corners. They grew out of our careful collaboration with providers to enhance the quality of care, and they prove that you can improve quality while reining in costs. By rewarding more preventive, more collaborative care, Blue Premier helps prevent serious and costly health problems before they arise.

For example, in 2020 our adult members with a Blue Premier provider saw a 15% reduction in unplanned hospital readmissions. 13 More members controlled their blood pressure.  Today, nearly 900,000 members (and counting) receive high-quality care from a Blue Premier provider. 14

More and more Blue Cross NC members are benefitting from our move to value-based care. By working with doctors and hospitals to change the way we pay for care, we’re making health care better, simpler and more affordable.

These advances are just the start. Blue Cross NC has committed to supporting independent providers and extending the reach of value-based care, so that more members will see the cost and quality benefits that value-based care can bring.

Building a Stronger Health Care system

North Carolina is a large and diverse state. We continue to serve members living in all 100 counties, as we have since the Affordable Care Act began. Blue Cross NC recognizes that many communities don’t have enough health care professionals.15 Our work to strengthen independent practices in every region of the state is keeping our members healthy and saving them money.

At the height of the COVID-19 pandemic, we invested heavily in a plan that has helped 513 local primary care practices­ – serving 500,000 members – weather financial challenges that few could have anticipated. 16

To strengthen the many independent practices that faced sudden decreases in patient traffic, we established our Accelerate to Value program and quickly began distributing “catch-up” payments to help eligible practices stay afloat. By the fall, we paid nearly $20 million17 to participating providers through this program, helping them through trying times and giving them a pathway into our value-based care program.

Last year, we collaborated with Deerfield Management Company to form the joint venture company Alo.  Alo provides independent practices with administrative support and the high-tech tools they need to coordinate patient care. It provides infrastructure and support services to reduce administrative burdens and help physicians avoid burnout. The joint venture makes it easier for physicians to share data and insights to identify and address opportunities to improve care. With these and other resources, Alo helps physicians maximize management flexibility, so that their practices will thrive during this period of tremendous change.

In addition, through our collaboration with Caravan Health we created an accountable care organization (ACO) that brings value-based care to rural and community hospitals across the state.

Our investments in independent practices play an important role helping North Carolinians in remote areas and underserved communities access health care that is more affordable and better quality.

Addressing non-medical drivers of health

Of course, we also recognize that good health depends on so much more than routine checkups and quality hospital care.

Meeting basic needs beyond traditional medical care is the foundation for good health, but not everyone has access to the same resources to meet these needs. Things like income, transportation, housing, and access to healthy foods and health care are all equally – if not more – important to our overall health. Health equity remains a concern, and many people face significant barriers to needed resources.

These indirect (non-medical) drivers of health play an important role shaping the overall health of a community. Data show a direct link between the zip code where we live and our life expectancy, which can vary widely for people living across a county line … or even across town … from one another. Simply put, those living in communities with fewer resources stand a greater chance of chronic health problems.

For example, the average life expectancy in Scotland County is 73 years. Just a few miles to the north in Moore County, it’s 79 years. That‘s a six-year difference.18 Our chances of living a healthy life shouldn’t come down to sheer luck.

Inequities in community health impact us all. A healthier North Carolina will reduce the strain on our health system and minimize reliance on emergency room visits. This ultimately lowers health care costs for everyone.

That’s why we’re committed to helping individuals and communities address drivers of health. Currently, Blue Cross NC efforts specifically prioritize food security, because a healthy diet is the most commonly reported unmet social need.

Food security is our priority, but it’s hardly the entire scope of our work. We are also testing new programs to address social isolation. This includes our support of efforts to help people with low incomes get transportation to vital health care services and our , no matter where they live.

Looking forward, forward thinking

Blue Cross NC has been serving North Carolina since 1933. For generations, we have remained committed to making health care simpler and more affordable.

Still, our eyes remain set on the future, focused on finding new ways to help our members get healthy and stay healthy. Why? Because Blue Cross NC is driven by a singular purpose: to improve the health and well-being of our customers and communities–and we won’t stop until health care is better for all.