Blue Cross and Blue Shield of North Carolina touted the success of its Premier Blue program, saying it helped the company saved $164 million in 2022 and $650 million since the launch of the product in 2019.
"Blue Premier is not only making healthcare more affordable and accessible; it’s improving the quality of care for our members," Troy Smith, Blue Cross NC’s vice president of affordability and value programs, said in a press release. “The year-over-year results show that Blue Premier is a sustainable model of collaboration in the healthcare system where the member is at the center of it all.”
A similar report released last September said Blue Premier saved Blue Cross NC about $130 million in 2021. The health plan partners with UNC Health, a not-for-profit state-owned medical system.
Blue Premier relies heavily on encouraging providers to use value-based healthcare, and many of those UNC providers have been taking on double-edge risk, or advanced risk, as Blue Cross NC calls it in its press release.
Physicians and hospitals participating in Blue Premier met their performance goals for the more than 1.4 million members they serve, said Blue Cross NC, and that resulted in an 18% reduction in unplanned hospital admissions last year compared to 2021 and a 15% increase in members who took steps to manage blood pressure.
In addition, the program resulted in about 10,000 more colorectal screenings than in 2021.
Payments to hospitals and physicians, including independent providers, are based on improved delivery of care rather than only the number of procedures or tests performed. Participating providers earned almost $438 million in shared savings and have reduced costs in the program’s first four years, including more than $117 million in 2022.
Blue Cross NC covers all 100 counties in North Carolina, and the Blue Premier program includes over 800 primary care practices throughout the state and 12 major hospitals and health systems.
“The systems and physicians currently in Blue Premier account for nearly 65% of Blue Cross NC’s total medical expense, excluding prescription drug costs,” according to the press release.
“Since starting this partnership, our UNC Health Alliance network physicians and hospitals have improved outcomes across chronic conditions like diabetes and hypertension while also building new infrastructure to directly care for patients with behavioral health needs," Mark Gwynne, D.O., president of UNC Health Alliance, the clinically integrated network and population health services organization at UNC Health, said in the press release. "Managing patients and families more holistically also means meeting them where they are by offering virtual care, hospital care at home and many other in-home needs, all of which Blue Premier has helped make happen.”
When Blue Cross NC unveiled the program in 2019, Fierce Healthcare noted that “the insurer has an established history of working with the health systems to find ways to drive down costs.” In the program’s first year, Blue Cross NC paid out $85 million in incentive payments to providers and generated $153 million in savings.
In its announcement last year, the insurer said that one of the ways it keeps costs down and improves quality is through its Advanced Kidney Care program, designed to slow or stop the progression of kidney disease.
Medicare spends $87.2 billion a year on chronic kidney disease, or $24,453 per beneficiary older than 65, according to the Centers for Disease Control and Prevention. Medicare fee-for-service spends $37.3 billion a year for patients with kidney failure. When the costs for prescription drugs are included, that comes to about $86,400 per person, or about 7% of Medicare paid claims cost.