Blue Cross, Aledade team up to support independent practices in North Carolina through ACOs

Doctor with patient
Blue Cross and Blue Shield of North Carolina and Aledade have announced an initiative to help independent physician practices. (Getty/wutwhanfoto)

A health plan and a startup company are pairing up to support independent primary care physicians in North Carolina.

Blue Cross and Blue Shield of North Carolina and Aledade, a well-funded startup that partners with primary care physicians to build and lead accountable care organizations (ACOs), are joining to launch a new initiative that will support hundreds of independently owned and operated primary care physician clinics in the state, according to an announcement Wednesday.

Doctors will be encouraged to join ACOs through which they can earn enhanced reimbursement rates and share in a portion of cost savings generated from the improved quality of care, the two organizations said.

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

RELATED: Focus on advanced primary care improves success of ACOs, study finds

The care model will allow doctors and other healthcare providers to work as a team to improve the quality of care for patients, better manage chronic diseases and ultimately lower healthcare costs, the two organizations said.

“With healthcare becoming unaffordable for too many North Carolinians, we must change the way we pay for care to focus on paying for healthier outcomes, not simply for the volume of tests and procedures. Primary care physicians influence a vast majority of healthcare spending, and their role in this transformation is critical,” said Patrick Conway, M.D., CEO of Blue Cross NC. He is also the former head of the Centers for Medicare and Medicaid Services' Center for Medicare & Medicaid Innovation.

Blue Cross North Carolina and Aledade will work together in this value-based care initiative to provide more resources and encourage data sharing with practices so they can better manage care while improving patient health outcomes.

The joint effort demonstrates both organizations' committment to help primary care practices remain financially independent, the announcement said.

Through the ACOs, the insurer will collaborate with Aledade to provide physicians with easy-to-use technology and data analytics tools. After joining these ACOs, practices will be able to gain a more comprehensive view of their patients’ total costs of care, gaps in quality of care and experiences throughout the entire healthcare system.

For example, physicians will receive notice whenever one of their patients visits the hospital or emergency room, so they can work with the patient to better manage ongoing health issues.

RELATED: BCBS of North Carolina’s Conway—Still work to be done in transition to value-based care 

Founded in 2014, Aledade partners with independent practices, health centers and clinics providing services to providers forming ACOs anchored in primary care. Across the country, Aledade ACOs have proven to improve access to primary care and reduce preventable hospital stays, emergency room visits and unnecessary services for Medicare beneficiaries as well as commercially insured members.

“This is a powerful vote of confidence in our physician-led model that is proven to help primary care practices successfully transition to value-based care,” said Farzad Mostashari, M.D., CEO of Aledade, who is also the former National Coordinator for Health IT for the Department of Health and Human Services. “Through commercial payer arrangements like this, we’re empowering independent physicians to deliver the benefits of value-based care to all of their patients.”

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