DURHAM — Blue Cross and Blue Shield of North Carolina is significantly expanding its support of primary care by creating “Accelerate to Value,” a program to help independently owned primary care physician practices remain financially viable and move to value-based care. The program helps ensure long-term access to high-quality care for Blue Cross NC members while enabling primary care practices across the state to weather the financial crisis created by the COVID-19 pandemic.
Accelerate to Value represents one of the most comprehensive efforts in the nation to help independent primary care doctors spend more time providing high-quality, cost-effective patient care, and less time worrying about the financial health of their practice.
“Collaborating with the primary care community has never been more important as this pandemic unfolds,” said Dr. Tunde Sotunde, MD, Blue Cross NC president and CEO. “Finding new ways for them to embrace and succeed in value-based care is an important step to better, simpler and more affordable health care for our members.”
Rahul Rajkumar, MD, Blue Cross North Carolina senior vice president and chief medical officer, agreed.
“Primary care providers across North Carolina are in a financial crisis,” Rajkumar said. “We have a duty and a desire to act. We’re here for primary care providers. Accelerate to Value will help them stay in business and improve their ability to provide the highest quality care to Blue Cross NC members and all of their patients.”
The program, open to independently owned primary care practices in North Carolina, includes:
» Financial stabilization
Blue Cross NC will provide significant financial support by making payments to participating practices, based on 2019 revenue, to improve financial stability in 2020 and 2021. These payments will begin by September.
» Transition to value-based care
Participating practices will commit to joining Blue Premier, Blue Cross NC’s value-based care program, by the end of 2020. Practices will have the option of joining an existing accountable care organization through a Blue Premier clinically integrated network or through Aledade, a company that helps primary care practices move to value-based care. Blue Premier jointly holds providers and Blue Cross NC accountable for meeting quality and cost standards.
» Capitated payments
Under a payment model known as capitation, beginning in 2022, the practices will be eligible to receive fixed monthly payments for meeting the health needs of their entire patient population. This replaces the fee-for-service method of getting paid for each patient encounter. Capitation encourages doctors to spend as much time as they need with each patient, helping them to improve their health.
The program comes as independent primary care practices — including family physicians, internists, pediatricians, geriatrics and OB-GYNs — are facing a sharp drop in revenue because of COVID-19. Since the start of the pandemic, patients have cancelled or delayed their doctor’s appointments and elective procedures. More practices and patients have turned to telehealth, but virtual visits have not fully made up for the loss of income.
Through the duration of the program, participating practices will take steps to improve clinical quality for Blue Cross NC members, including ensuring access to care, adopting and expanding telehealth, using electronic health records, and delivering preventive care and care coordination activities responsive to the COVID-19 pandemic. Practices that meet program requirements will receive a new contract amendment from Blue Cross NC. Additional information for practices is available on Blue Cross NC’s website.
Blue Cross NC has taken significant actions to help members during this public health crisis, including waiving cost-sharing for testing and treatment related to COVID-19, expanding virtual care coverage and increasing access to medication. In addition, Blue Cross NC has taken multiple steps to make things easier for providers by speeding payments and removing barriers to care.
Practices that would like to apply for the Accelerate to Value program should visit bluecrossnc.com.
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