4 Payers That Have Embraced Value-Based Care Models in 2021
In the first six months of 2021, payers have continued to strike deals that involved value-based care models despite the effects of the coronavirus pandemic.
Source: Getty Images
- Updated 6/11/2021: This article has been updated with a quote from Blue Cross and Blue Shield of Minnesota's chief medical officer. A previous version included an quote from a partner of Blue Cross Blue Shield of North Carolina.
Despite the lingering impacts of the coronavirus pandemic, payers are continuing to make progress with value-based contracting in 2021.
At the beginning of 2021 as much of the country remained unvaccinated, payers stalled their value-based contract negotiations, according to an Insights report. Participation in the most common alternative payment model—the pay-for-performance model—dropped by 18 percent in 2020, meaning that less than half of the survey respondents were in this payment model.
Payers and their provider partners invested their energies in increasing coronavirus testing and pushing the coronavirus vaccine out to eligible members.
Although value-based contracting did suffer a stalled start in 2021, a handful of payers have moved forward with value-based contracts in the first half of the year.
Blue Cross Blue Shield North Carolina
READ MORE: Humana Expands Value-Based Care Model to Cover More Seniors
Blue Cross Blue Shield North Carolina (Blue Cross NC) has announced a couple of value-based care agreements in the first six months of 2021.
Early in the year, Blue Cross NC entered into a value-based contract with Fresenius Medical Care North America (FMCNA) and Strive Health to serve patients with chronic kidney disease. The partners emphasized care coordination as a major goal of this agreement and reimbursement will be based on total cost of care and quality performance measures.
The payer started its value-based care Medicaid managed care program, Healthy Blue, in March 2021. Coverage in Blue Cross NC’s prepaid plan will start on July 1. The health plan will receive rewards from the state’s Medicaid program for positive health outcomes among beneficiaries.
Blue Cross NC and the other five prepaid health plans are allowed to cover social determinants of health support for Medicaid beneficiaries.
In late May, the payer revealed its agreement with Mission Health that extended value-based care to members in the western part of the state as well as Medicaid beneficiaries. On January 1, 2022, the health system will join the Blue Premier network.
READ MORE: Health System Joins Blue Cross NC to Expand Value-Based Care
With the addition of this provider, Medicaid managed care beneficiaries with Blue Cross NC’s management will have access to a broader network of healthcare professionals.
Humana
Humana has seen success with its value-based care models in the past, as particularly documented in the Medicare Advantage space through the annual Bold Goal report. has engaged in a couple of value-based care advancements
In February 2021, the payer launched a pilot program under Humana Care Support. The program sought to use value-based payment models to improve chronic disease management for seniors in Medicare Advantage.
Additionally, CMS selected Humana to participate in its value-based care transition program for traditional Medicare. As part of this program, the payer will strike value-based care agreements with providers using the Global and Professional Direct Contracting Model.
By early May—a month into the program—Humana had signed value-based contracts with 420 primary care providers.
READ MORE: Humana Joins Traditional Medicare Value-Based Contracting Model
Humana also launched and expanded its CenterWell Senior Primary Care model in the first few months of 2021. The payer is transitioning some of its senior services into the new brand in part in order to improve its value-based care strategy for the elderly.
“The transition to CenterWell Senior Primary Care reinforces our commitment to an integrated, value-based care model that puts our senior patients and their unique physical, social and emotional needs at the center of their own wellness journeys,” Reneé Buckingham, segment president of Humana’s care delivery organization, said when the company announced its decision.
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Minnesota (Blue Cross) also started a value-based care agreement in April 2021. The agreement targeted chronic kidney disease management and end stage renal disease care.
Blue Cross signed its value-based contract with Village Health, a DaVita Integrated Kidney Care program, and centralized around four factors.
The agreement emphasized smooth care coordination between the numerous care providers that are needed to offer chronic kidney disease care management.
The partners would also promote patient education and preventive services around chronic kidney disease. They would achieve this goal primarily through primary care services providers.
Data analytics would be key to this partnership as the payer and provider tried to identify at-risk members and intervene early.
Lastly, the payer and provider would utilize community-based efforts to inform members about their risk for chronic kidney disease. These efforts would be accessible to the community both in-person and virtually.
"We have a significant opportunity to help delay the progression of kidney disease and better meet the complex health needs of those with kidney failure,” said Mark Steffen, MD, chief medical officer at Blue Cross. “By collaborating with VillageHealth, we are committed to enhancing the quality of life for thousands of members, while simultaneously reducing the cost of care by improving outcomes related to kidney disease.”
MVP Health Care and the University of Vermont Health Network
In April 2021, MVP Health Care, a nonprofit payer, and the University of Vermont (UVM) Health Network, an academic health system, announced that they would be starting a health plan that serves members through value-based contracting.
The partners stated that they would use established value-based care models such as the All Payer Model in Vermont or the payment reform initiatives in New York. Based on the payer and health system’s comments, preventive care services will likely be a hallmark of this health plan.
The health plan will be available to Vermont and northern New York residents during the 2022 open enrollment in the fall. Benefits will go into effect on January 1, 2022.
