Rewarding value over volume
The traditional payment relationship between doctors and health insurers has been fee-for-service. This means that the more procedures doctors perform, the more they’re paid. However, this relationship has stood in the way of high quality, affordable care for patients – the exact thing both providers and payers want.
We’ve charted a new path forward with our Blue Premier value-based care initiative, rewarding value over volume. Collaboration is at the heart of this new model. Doctors, hospitals and Blue Cross NC are held jointly accountable for better health outcomes, exceptional patient experience and lower costs.
But Blue Premier goes a step farther. Through a “shared risk” financial model, a participating health system shares in cost savings if it meets goals to improve patient health – but also shares in the losses if it falls short of agreed-upon targets. Blue Premier also provides resources for more care coordination. This model helps doctors and health systems actively manage a patient’s health care conditions, leading to fewer hospital visits and better health overall.
Our providers have been eager to make the move to value right along with us. Eight leading health systems in North Carolina now participate in Blue Premier.
It’s projected that Blue Premier will result in medical cost savings of 15% over 10 years. It’s one reason we’re able to lower our individual Affordable Care Act (ACA) customers’ 2021 rates by an average of about one percent. Blue Cross NC has now lowered rates for individual ACA customers for the third straight year, resulting in rates more than 10% lower for these customers than they were in 2018.