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URGENT: SB 432, which will enable Big Pharma to raise drug costs even higher, just moved one step closer to passing. 

Blue Cross NC to Lead Partnership Aimed at Halting Healthcare Cost Increases

February 13, 2019

A new coordinated healthcare partnership called Blue Premier aims to stop North Carolinians from seeing red over rising costs and inefficient care.

Blue Cross and Blue Shield of North Carolina—the state’s largest health insurer—is leading the collaboration with five of the state’s preeminent health systems to share in outcomes and costs associated with care. Dubbed Blue Premier by the NC insurance giant, the model shifts the provider mindset from quantity to quality.

Under the new plan, compensation for doctors and hospitals draws on the value provided to the patient, rather than the amount of treatment given. Blue Premier also emphasizes efficient care, with the providers now pairing with Blue Cross to foot the bill for any cost overruns.

In coverage of the announcement, leadership from the insurer stressed that the new model’s intention is not to save money by sacrificing time and care spent on the patient. Rather, Blue Premier expects to hold providers responsible for the outcomes of their patients.

To ensure accountability, the insurer measures providers on indicators predicated on reducing infections, surgical complications, hospital readmissions, and deaths, along with the delivery of diagnostic preventive screenings for illnesses such as cancer and diabetes.

Blue Cross expects about half of the 3.8 million North Carolinians it insures to be active within the new model by 2020.  The hospitals that have already agreed to participate in Blue Premier are WakeMed Health & Hospitals, UNC Health Care, Duke University Health System, Cone Health and Wake Forest Baptist Health. Atrium Health, Vidant Health, and Novant Health are in discussions about taking part in the future.

The partnership represents what could be a significant step on behalf of the insurer and the health systems to stem the outrageous increases plaguing patients across our state.

In fact, the goal of the new model is to eliminate any annual healthcare cost increase. According to Blue Cross, the current average annual cost increase is more than 5%.

But there are some concerns among some participating hospital CEOs about Blue Premier’s structure and how it could affect patient care. The model closely follows the strategies imposed by other groups, some of which have been with met with subpar results due to poor cost projections or an inability to meet outcome targets.

In Blue Premier’s case, Blue Cross will serve as a central agent among the hospitals, sharing patients’ medical bills with the providers. The goal of this process is to provide complete visibility into a patient’s medical history to avoid what could be a redundant or ineffective treatment.

However, the networks don’t include every doctor or provider the patient may have seen, which is where the system can cause some frustrations. Still, the method has the chance to decrease prices and increase the value delivered.

Blue Premier facilitates the sharing of medical claims among the providers, so each hospital will now have visibility into how much other providers charge for certain procedures. Providers can use this type of intel for comparisons that ensure one provider isn’t far outpacing a peer.

Plus, according to one professor of health policy at UNC Chapel Hill, doctors aren’t likely to avoid basic health screenings for the sake of saving money now as it could cost them big bucks later. That’s good news for patients who may now learn about a treatable condition before it worsens or becomes life-threatening.

These types of quality-over-quantity programs have been gaining steam in other parts of the country for the last decade. Fortunately for North Carolinians, there is data available that supplies a blueprint for a successful model for both the patient and the provider.

Have the sky-high costs of healthcare in our state impacted you and/or your family’s lives? Do you want to do something about it? Join the Coalition now to receive updates about new legislation and policies that will affect YOUR healthcare. Sign up now!


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