Value-based care is a concept embraced in different ways by health care providers in the Wilmington region. And the transition from standard health care models has its own unique complexities, said officials keeping tabs on a major value-based initiative from the state’s largest insurer.
Blue Cross and Blue Shield of North Carolina in January announced a program called Blue Premier “to transform health care across the state,” according to a BCBSNC news release.
Five major health care systems signed on.
Blue Premier “is a new value- based model of care in which Blue Cross NC and the health systems will be jointly responsible for better health outcomes, exceptional patient experience and lower costs,” the release says.
With agreements from the five state health systems and their accountable care organizations, Blue Premier “is one of the most rapid and comprehensive shifts to value- based payments in the nation,” the release says.
The participating systems are Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health and WakeMed Health & Hospitals.
Blue Premier “rewards quality of care and bends the cost curve by holding providers financially accountable for higher costs and inefficiencies in the health care system.”
In the Blue Premier model, “inefficiencies turn into an expense rather than revenue for a health system,” insurer officials said.
Blue Premier ties payments to doctors and hospitals over time to the value of services that improve patient health, meaning that total payments to the health systems under Blue Premier “will be based on the health systems’ ability to manage the total cost of care and their overall performance, measured by industry quality standards,” the release said.
In the “shared risk” financial model, the health systems will share in cost savings if they meet industry- standard goals to improve the health of patients – and share in the losses if they fall short.
While none of the five participating health care systems are based in Wilmington, the implications of value-based models like Blue Premier can be far reaching.
Wilmington Health is still studying Blue Premier and similar plans, said CEO Jeff James.
“It’s something that we are considering,” James said. “In general, we support value-based care,” a concept he said Wilmington Health has been transitioning to since 2012.
“It is very common in large, independent practices. We were very early a [participant] in value-based care, one of the earliest in the state of North Carolina,” James said.
James believes that with adjustments, the value-based concept can be good for the health care system. He said the Medicare value-based system “has performed very well” for both Wilmington Health and its patients.
“In our system we have higher quality outcomes to patients in the years we have participated,” James said.
Since 2013, he said, Wilmington Health has delivered service in the top 5 percent of value among comparable care organizations while being in the lowest 5 percent of overall cost.
“We’re looking at it,” he said of Blue Premier. “We’ve not yet made a decision about participation. Every payer has a slightly different value- based system.”
Wilmington Health’s methodology “is more community-based,” he said, with strong connections to local physicians and health care providers.
A lack of transparency in commercial value-based systems is one of the major shortcomings in the system, James said.
That factor makes it challenging for customers to assess the differences in each plan.
“Medicare is doing a good job of addressing it, however the commercial carriers are well behind the federal government in providing transparency in terms of [comparing] low-cost providers,” he said.
Wilmington Health has been preparing for the advent of value-based health care for almost 10 years, developing a culture to address the changes in the process.
“We’ve positioned ourselves to survive in a value-based system, and the only thing that’s holding us back is true transparency,” James said. “Commercial carriers have yet to incorporate the levels of transparency necessary for high-performing organizations to thrive.”
Other health care organizations also embrace the value-driven model.
New Hanover Regional Medical Center “has been driving value by continually working to lower the cost of delivering increasingly complex care while simultaneously improving the quality of it,” NHRMC President and CEO John Gizdic said in an email response to questions. “We’re doing this with our NHRMC Physician Group and other community providers who are helping to lead projects to standardize care, eliminate inefficiencies and remove the barriers that can stand in the way of someone getting and staying well.”
Gizdic said the progress of NHRMC and affiliates in driving value “is evidenced by the success of our accountable care organization, Physician Quality Partners.”
Physician Quality Partners ranked first in North Carolina and sixth nationwide for performance among established ACOs in the 2017 Medicare Shared Savings Program and Merit Based Incentive Payment System.
“While the insurance companies are focused on individual charges, we, as the caregivers, see the whole patient and the circumstances that can influence their health,” Gizdic said.
According to a statement from a Novant Health spokesperson, the Winston-Salem based health care system that operates Brunswick Novant Medical Center “has thoughtfully approached the navigation from fee-for-service to value-based care over the past several years.”
“From our perspective, a healthcare system where quality, cost and patient experience becomes the economic driver closely aligns with our mission to improve the health of our communities, one person at a time. We participate in value-based programs with virtually every payer today and will continue our diligence regarding BCBSNC’s new program,” according to the statement.
“Though not part of the current announcement, Novant Health is actively engaged with evaluating the Blue Premier model across Novant Health in North Carolina.”
The health care system also established the Novant Health Clinically Integrated Network, which includes independent physicians.
“Additional efforts to transition to value-based care,” according to Novant officials, “include the creation of Adept Health, which focuses on partnerships with healthcare organizations to provide shared services and other management collaborations.”