Initiative reaches $650M in NC cost savings Blue Premier healthcare initiative reaches $650M in NC cost savings

The Blue Premier health-care initiative of Blue Cross Blue Shield of N.C. reported Tuesday that it generated nearly $164 million in health care cost savings for more than 1.4 million North Carolinians during 2022.

Blue Premier debuted in early 2019 with most of the state's largest healthcare systems reaching partnerships that year. That includes Atrium Health Wake Forest Baptist, Cone Health and Novant Health Inc.

As of Tuesday, agreements are in place with 12 major hospitals and health systems, as well as more than 800 independent primary-care practices.

With the $164 million in cost savings achieved in 2022, Blue Cross said the initiative has achieved nearly $650 million over four years.

The goal is providing a value-based health-care initiative "expected to improve cost controls while maintaining or even improving care," according to the insurer.

In a "fee for service" system, patients or insurers pay providers for each office visit or treatment, creating additional revenue for repeat visits or hospital readmissions.

The Blue Premier approach typically offers providers incentives for better patient outcomes through emphasizing preventive and maintenance care, which tends to be less costly than treating patients after they get sick.

Blue Premier features a "shared risk" format that's also a focal point of recent state Medicaid overhaul. Providers share in cost savings if they meet patient-care goals - as well as in the losses if there are cost overruns.

The insurer said that since 2019, providers earned almost $438 million in shared savings by improving quality and reducing costs in the program's first four years, including more than $117 million in 2022.

"Blue Premier is not only making health care more affordable and accessible; it's improving the quality of care for our members," said Troy Smith, vice president of affordability and value programs at Blue Cross NC.

"The year-over-year results show that Blue Premier is a sustainable model of collaboration in the health care system."

Specific examples of quality improvements for Blue Premier-participating providers included:

An 18% reduction in unplanned hospital readmissions among adult members seeking care at a participating health care system, compared to 2021A 15% increase in the percentage of members who took steps to manage blood pressure in 2022, compared with 2021About 10,000 more colorectal screenings than in 2021

Mark Hall, a professor of law and public health at Wake Forest University and a national health-care expert, said it remains to be seen how much of a game-changer Blue Premier might be.

"But, it is a significant development toward much-discussed but yet-to-be-implemented value-based contracting in health care," Hall said.

Pluses, minuses

Blue Premier said it represents the latest phase of the "patient-care medical home" and accountable-care organization initiatives that have centered on early intervention and closer monitoring of patients with chronic diseases and the quality of care provided.

In those initiatives, providers are incentivized to offer additional office hours, whether weeknights or weekends, and spend more time with patients per visit.

It could involve being proactive in checking on patients after they are released from a hospital to see that they are taking their medicine as prescribed, as well as encouraging regular checkups - including transportation options - for people with chronic illnesses.

Some advocates have expressed concerns that value-based payments for private-insurance customers could be a step toward rationing care if insurers are allowed to set a flat reimbursement rate per patient similar to state Medicaid overhaul.

Health-care system officials acknowledge the initiative represents a cultural change for all parties in how services are delivered.

Rep. Donny Lambeth, R-Forsyth, is the author of the N.C. House bill that focuses on Medicaid expansion in the state.

"I think the general idea is a good one and a positive step," Lambeth said of Blue Premier.

"Any proactive plans by providers, even in a group of more than one, that helps better manage patient care and reduce cost while improving outcomes is good for the marketplace.

[email protected]@rcraverWSJ