Blue Cross NC's value-based program saved $130 million in 2021
Providers earned almost $321 million in shared savings by improving quality and reducing costs in the program's first three years.
Photo: Tempura/Getty Images
Blue Cross and Blue Shield of North Carolina's Blue Premier program, which emphasizes value-based healthcare, saved members about $130 million in health costs in 2021, and almost $500 million total since the program first launched three years ago, Blue Cross NC said.
Since the program is largely value-based in nature, hospital and doctor payments are based on successful treatments rather than just on the number of procedures or tests performed. This, the insurer said, has resulted in fewer unplanned hospital admissions and more preventative care.
Dr. Stephen Friedhoff, senior vice president of Healthcare Services at Blue Cross NC, said improving care quality is the organization's No. 1 priority.
"When we can help make healthcare more affordable, accessible, and easier to navigate, we make it better for all," he said.
Providers participating in Blue Premier delivered care to nearly 1.4 million members in 2021, up from about 857,000 the year before.
Blue Cross NC touted a number of quality improvements achieved since the program's inception, including a 5% reduction in unplanned hospital readmissions among adult members seeking care at a Blue Premier facility, compared with 2020; a 12% increase in the percentage of members who took steps to manage blood pressure in 2021, compared with 2020; and about 24,000 more colorectal screenings than in 2020, averting up to 570 preventable deaths from colorectal cancer, according to health screening calculations from the U.S. Preventive Services Task Force.
WHAT'S THE IMPACT
A growing number of Blue Premier providers are in shared-risk agreements, meaning they're accountable financially for meeting cost and quality standards. According to BCBS, providers earned almost $321 million in shared savings by improving quality and reducing costs in the program's first three years, including over $100 million in 2021.
These and other quality improvements are included in performance calculations that Blue Cross NC has made in collaboration with Blue Premier providers. In addition to the estimated $130 million saved in 2021, 2020 saw about $197 million in savings while 2019's total reached $153 million.
The $130 million in savings in 2021 is broken into two areas – $110.6 million for traditional Blue Premier participants and $19.5 million in savings from the Blue Premier Advanced Kidney Care program. The AKC program is designed to slow or stop the progression of kidney disease.
Since the program started, agreements are in place with 12 major hospitals and health systems and almost 800 independent primary care practices across the state. The systems currently in Blue Premier account for nearly 70% of Blue Cross NC's total medical expense, excluding prescription drugs.
THE LARGER TREND
Earlier this summer, Blue Cross NC made a play for the mental health space, joining forces with Headway, a company that works with insurers to deliver behavioral healthcare. The collaboration is meant to address what the company sees as a serious problem: a shortage of mental health professionals in the state.
The collaboration comes as Blue Cross NC is investing more than $2 million to support 11 community organizations working to improve access to behavioral health services. The initiative is aimed at enhancing access in rural and marginalized communities and in regions of the state designated as Health Professional Shortage Areas.
The Blue Premier program is a shared risk contract with health systems and their accountable care organizations. The program ties payment to performance: The health systems share in the cost savings if they meet industry-standard goals to improve the health of patients and reduce costs. The health systems also share in the losses if they fall short.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
