Reimbursement

NC Blue Cross Shifts to Value

January 25, 2019



Blue Cross Blue Shield of North Carolina and five major health systems recently announced a major shift to value-based care.

The organizations are joining together in a new program that creates a “quality contract” between the insurance company and the providers in which payment will be based on how well providers improve patient outcomes and lower costs. Using a “shared risk” model, the health systems will share in cost savings with Blue Cross if they meet industry-standard goals to improve the health of patients—and share in losses if they fall short.

 

Blue Cross says that by early 2020, half of its members will have access to a provider who operates in this type of model and that all members will be covered under the new program within five years.

The health systems in the program are:

 

  • Cone Health
  • Duke University Health System
  • UNC Health Care
  • Wake Forest Baptist Health
  • WakeMed Health & Hospitals

 

View Blue Cross press release