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While the concept of value-based care is not new, it is certainly gaining traction in the health care industry. The reason is simple. With almost everything that we purchase in life, there’s the applicable saying: “You get what you pay for.” But with health care, that just doesn’t ring true. Right now, those in the health care system are rewarded for doing more, even when that “more” may not be safe, effective or necessary. And unfortunately, that means we all end up paying more for that care, even when we are not getting the health outcomes that should be associated with the heavy price tags.

Unfamiliarity with the concept of value-based care has led to some confusion and misinformation, but at its simplest it’s insurers and health care providers (e.g. doctors) coming together in a commitment to improve quality, patient experience and affordability.

This shift to value is taking place across the state through our program Blue Premier. With seven of the largest North Carolina health systems now in Blue Premier agreements (Novant Health, Atrium Health, Cone Health, Duke University Health Systems, UNC Health Care, Wake Forest Baptist and WakeMed Health & Hospitals), we’re proud to call our program the most rapid and comprehensive shift to value-based payment in the nation by any health plan.

We know that many of our members see physicians at these seven health systems, so we want you to be in the know about what this new model means for you. Here are three reasons value-based care is better for members.

1. There will be an increased focus on the quality of care you receive.

In the value-based care model, there is an increased focus on outcomes. In fact, doctors and hospitals will now be incentivized for better managing your health and care. For example, while doctors will always be paid when you are treated, the better they manage your health outcomes and care, the more they’re reimbursed (payed). This model is shifting the way doctors are paid – putting an increased focus on quality and not quantity, which is a good thing.

One of the biggest benefits of our program is care coordination. We strongly believe in the comprehensive approach to medical care, and this model puts a large emphasis on making sure your primary care provider and specialists are connected when it matters most.

One way we’re doing this is with behavioral health. We know that those with mental health or substance use issues have higher medical expenses than those without. Coordination between a primary care doctor and a behavioral health specialist has a significant impact on ensuring health goals are achieved with both physical health and mental health. We’ve already begun to implement this with our collaboration with Quartet.  

Gone are the days where physicians are paid based on the volume of procedures, regardless of efficiency or health outcomes. The focus now will be on managing health conditions with an increased emphasis on prevention.

2. You will build a stronger relationship with your doctor.

Have you ever felt like you were rushed out of your doctor’s appointment without fully addressing all your questions? In the value-based care model, providers are encouraged to spend more time with patients in order to build relationships so they can allocate the best resources and treat patients sooner rather than later. By spending more time with their patients, asking more questions and coordinating care, physicians will be better equipped to identify the root cause of health issues and provide patients with resources to encourage prevention and wellness. It’s our experience, and data shows, that most patients want to be healthy, and when doctors spend the time to provide the resources so patients can work on their health, they benefit greatly.

3. Your primary care provider will be at the center of care.

While we know many individuals do not have a relationship with a “regular doctor,” value-based care will help to change this. Our goal is for individuals to shift their perception of medical care and put their primary care physician and team at the center of their care plans. Instead of heading to the emergency room when there is a health issue, the first call should be to a primary care provider. A trip to a primary care provider is significantly less expensive than a trip to the emergency room, so relying on a primary care provider, patients can receive high quality care at a lower cost. For example, according to Blue Cross NC claims data, the bill for a typical ER visit is about $1,900. What’s more, one study revealed that only 29 percent of emergency room patients actually required ER-level care. (Read more on that, here.)

We’re also helping to change the way care is delivered – we want care to be convenient. With things like telehealth, we’re making it easier for patients to receive medical care from wherever they are. The burden of having to miss work or leave early to go to the doctor is reduced since care can be accessed in different ways (e.g. video chat). By strengthening the relationship between a member and primary care provider, we can reduce unnecessary spending while also ensuring that there’s a medical professional that is familiar with the individual’s medical history and ready to act.

We know that the shift to a better health care system cannot happen overnight, but we’re encouraged by the progress we have already made and know this step will help our customers live healthier lives, with less frustration navigating the health care system and lower costs for all.

 

This post was written by JP Sharp and Troy Smith of Blue Cross NC.

JP Sharp

About

JP Sharp, JD, MPH, is the Director of Special Projects for Enterprise Strategy at Blue Cross NC, where he was previously the Director of Healthcare Strategy and Transformation and led the design of new payment models, such as Blue Premier, and strategic healthcare initiatives to transform care delivery and affordability. Prior to Blue Cross NC, JP worked at the CMS Innovation Center, where he led the development of the Next Generation ACO Model and the Quality Payment Program under MACRA. JP received his JD from the University of Michigan Law School, MPH from the University of Michigan School of Public Health, and his AB in psychology from Harvard University.