Blue Cross NC’s Premier Blue program reported saving $164M in 2022 and $650M since 2019. The program focuses on value-based healthcare, reducing hospital admissions by 18% and boosting proactive blood pressure management by 15%. Payments are based on care quality, not procedure volume. Blue Premier’s network covers 100 North Carolina counties, including 800+ practices and 12 major hospitals. The program tackles chronic conditions and behavioral health needs. Medicare’s $87.2B annual spend on kidney disease is addressed, with savings of $153M generated in the program’s first year.
Blue Cross and Blue Shield of North Carolina have celebrated the achievements of its Premier Blue initiative, highlighting its contribution to a remarkable $164 million in savings during 2022 and an impressive total of $650 million since its launch in 2019.
According to Troy Smith, Vice President of Affordability and Value Programs at Blue Cross NC, the Blue Premier program not only enhances healthcare affordability and accessibility but also elevates the quality of care provided to its members. He emphasized that the consistent year-over-year outcomes demonstrate Blue Premier’s sustainable collaborative model within the healthcare system, placing the member at its core.
In a similar report released in September of the prior year, it was revealed that Blue Premier had saved Blue Cross NC approximately $130 million in 2021. The program operates in partnership with UNC Health, a not-for-profit state-owned medical system.
The core of Blue Premier’s approach revolves around incentivizing healthcare providers to adopt value-based healthcare practices. Many of UNC’s providers have undertaken advanced risk, referred to as double-edge risk by Blue Cross NC, as highlighted in their press release.
According to Blue Cross NC, participating physicians and hospitals within the Blue Premier program successfully met performance targets for the over 1.4 million members they serve. This achievement translated to an 18% reduction in unplanned hospital admissions compared to 2021 and a 15% increase in members proactively managing their blood pressure.
Moreover, the program facilitated around 10,000 additional colorectal screenings in comparison to the previous year.
Unlike traditional reimbursement models based solely on the volume of procedures or tests, Blue Premier’s payment structure rewards hospitals and physicians, including independent providers, for improved care delivery. Over the program’s initial four years, participating providers collectively earned nearly $438 million in shared savings, resulting in substantial cost reductions, including over $117 million in 2022.
Encompassing all 100 counties in North Carolina, Blue Cross NC’s reach extends to a comprehensive network that includes more than 800 primary care practices across the state, in addition to 12 major hospitals and health systems as part of the Blue Premier program.
A significant highlight is the fact that the systems and physicians currently engaged in Blue Premier account for nearly 65% of Blue Cross NC’s total medical expenses, excluding prescription drug costs.
Mark Gwynne, D.O., President of UNC Health Alliance, expressed the program’s positive impact on patient outcomes, particularly in managing chronic conditions such as diabetes and hypertension. He also highlighted the establishment of new infrastructure to cater to behavioral health needs and the provision of various in-home care services.
Notably, Blue Cross NC’s history of collaborating with health systems to drive cost reduction was acknowledged when the Blue Premier program was unveiled in 2019. The inaugural year of the program witnessed incentive payments totaling $85 million to providers, generating savings of $153 million.
In their previous announcement, the insurer underscored the significance of their Advanced Kidney Care program in curbing the progression of kidney disease, a crucial initiative considering Medicare’s substantial expenditure of $87.2 billion annually on chronic kidney disease.
The Centers for Disease Control and Prevention’s statistics reveal that Medicare fee-for-service spends $37.3 billion each year on patients with kidney failure, and when prescription drug costs are factored in, the figure rises to around $86,400 per individual, constituting approximately 7% of Medicare’s claims cost.
