Blue Cross and Blue Shield of North Carolina touted major savings thanks to improved outcomes racked up by providers and the insurer through its Blue Premier program that relies heavily on value-based healthcare.
When we can help make health care more affordable, accessible, and easier to navigate, we make it better for all,” Stephen Friedhoff, M.D., Blue Cross NC’s senior vice president of healthcare services, said in a press release.
Blue Premier relies heavily on encouraging providers to use value-based healthcare. The number of successful treatments rather than just the number of treatments offered to members figures into remuneration for the insurer’s 12 major hospitals and approximately 800 physician practices across North Carolina. About 1.4 million members participated in Blue Premier in 2021, up from 857,000 members in 2020
Of course, data from the COVID-19 pandemic years need to be examined with care. A Blue Cross NC spokesperson told Fierce Healthcare that “our claims data show members did not defer wellness and preventative care in 2021 as some did in 2020, with claims largely returning to pre-pandemic levels. At a time where you would think to see deferred care, you see in this data that it didn’t happen at the level it did in other states.”
The use of value-based care meant that providers earned nearly $321 million in shared savings since Blue Premier’s launch, with over $100 million of that being earned in 2021.
When Blue Cross NC unveiled the program in 2019, Fierce Healthcare noted that “the insurer has an established history of working with the health systems to find ways to drive down costs.” In the program’s first year, Blue Cross NC paid out $85 million in incentive payments to providers and generated $153 million in savings.
In today’s announcement, the insurer pointed to some of the ways it kept costs down and improved quality. For instance, it saw $19.5 million in savings through its Advanced Kidney Care program, designed to slow or stop the progression of kidney disease. About 1 in 7 adults in the U.S. suffer from chronic kidney disease, according to the Centers for Disease Control and Prevention (CDC).
According to the last available data from 2019, Medicare spends $87.2 billion a year on chronic kidney disease, or $24,453 per beneficiary older than 65, according to the CDC. Medicare fee-for-service spends $37.3 billion a year for patients with kidney failure. When the costs for prescription drugs are included, that comes to about $86,400 per person, or about 7% of Medicare paid claims cost.
The Blue Cross NC spokesperson said that “when it comes to measuring goals, Blue Premier holds participating providers and Blue Cross NC jointly accountable for meeting quality and cost measures. Quality is determined by agreed-upon clinical guidelines and are spelled out in Blue Premier agreements signed by the providers and Blue Cross NC. Blue Premier providers are accountable for ensuring that members take appropriate steps specific to their conditions; this accountability allows providers flexibility to address specific clinical situations but also provides standard, measurable goals for patient outcomes.”
Source: Fierce Health Care