How Payers Can Drive A Quicker Transition to Value-Based Care

December 16, 2020 - Value-based care is a perennial goal for the payer industry, but transitioning into risk-based, outcomes-based contracts has proven to be a slow process.

However, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) used its Blue Premier program, which it launched in early 2019, to achieve 52 percent membership in value-based care arrangements by mid-December 2020.

Von Nguyen, MD, chief medical officer of Blue Cross NC, pointed to the payer’s partnerships with providers to explain the rapid shift.

“The thing that's made North Carolina unique and actually gotten us to a place where we can move quickly is the partnership with providers,” Nguyen told HealthPayerIntelligence.

“We have strong partnerships with many of the provider systems in North Carolina. Eight of the largest systems have actually signed on as Blue Premier partners, in addition to hundreds of independent primary care practices.”

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But it was not just the number of partnerships or the size of Blue Cross NC’s partners that moved the payer’s membership towards value-based care.

Nguyen named three factors that helped the payer pivot towards value-based care more decisively.

Establishing multi-year agreements

First, Blue Cross NC used multi-year agreements with its provider partners.

“That partnership and the ability to sign multi-year agreements with these value-based providers has been important to make sure that we provide a pathway or a glide path into value-based care,” explained Nguyen.

The multi-year format for value-based contracts acknowledges that providers might not achieve success in value-based care immediately. Rather, this format aims to set providers up for success in value-based care over time.

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Nonetheless, Nguyen and his team at Blue Cross NC were surprised by Blue Premier providers’ achievements in value-based care in the program’s first year.

“We made about $85 million in performance payments to providers in that first year of Blue Premier,” Nguyen said. “And that worked because we were willing to work with providers in terms of sharing the financial risks associated with caring for members while also improving the quality for members.”

Building trust through data exchange

The second factor was building trust between the payer and provider partner.

“Plans and providers sitting down and having a conversation and deciding to work together to support members is a critical first step step; and recognizing that healthcare as it is simply isn't affordable and that we have to work together,” Nguyen said.

“Once you agree that you want to work together, then there are a number of things that are important to continue to build upon that trust.”

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Specifically, Blue Cross NC used data exchange to ease communication and collaboration.

Payers may focus on two aspects of the data exchange process if they want to leverage it to build trust, Nguyen recommended.

When incorporating new data gathering and data exchange procedures, payers need to understand their provider partners’ workflows.

“When we bring any solution to bear with the provider, we sit down with providers in a meaningful way and ask them the question: with this potential solution, how does it fit into your workflow? How could we make it easier?” Nguyen described.

Additionally, payers need to be mindful of the entire care team’s experience with a new data exchange process, not just a single provider.

Value-based care models reject the idea that providers work in silos, preferring to rely on coordinated care. Thus, it is crucial for payers to engage with the larger infrastructure as they build trust with providers through data exchange, Nguyen shared.

This concept carries into the third factor.

Honing payer, provider care coordination

The third factor that payers can leverage in order to drive a faster shift toward value-based care is effective care coordination.

Many payers tackle care coordination by providing a case manager for the member. But with hospitals taking the same approach and with primary care providers maintaining personal ties to the patient as well, communication can get muddled.

“It’s about partnering with members to really understand who is the quarterback—it's usually the primary care provider—and empowering that primary care provider to take care of that patient—both from a treatment perspective, but also from a preventative perspective—and really having that strong partnership with them to provide tools as well as data and the financing to do all of those things,” Nguyen summarized.

When the pandemic hit in 2020, Blue Cross NC continued pursuing its goal of transitioning more members into value-based care arrangements.

It may seem counterintuitive to introduce greater reliance on outcomes-based, risk-based value-based care models during a pandemic. But instead, the pandemic underscored the significance and value of such models, according to Nguyen and other healthcare leaders.

The need to halt in-person elective care during the early months of the pandemic put many fee-for-service providers in a difficult position. The low volume of patients meant little to no income particularly for independent providers, pushing many towards bankruptcy. Even months into the pandemic, providers continue to face serious financial challenges.

“We absolutely did focus on the pandemic, but we also saw an opportunity to highlight one of the strengths of value-based care: the idea of getting a constant revenue stream that can actually support practices during errant times when you don't have constant volume,” Nguyen explained.

“Subsequently, we also provided a pathway for these independent providers to move into capitated arrangements, which would secure a stable revenue mechanism for them even in a situation where a pandemic might drop their volume.”

In 2021, Blue Cross NC plans to continue this trend of putting more members in value-based care arrangements. The payer’s overarching goal is to have all of its members in Blue Premier value-based contracts by 2024.

Additionally, the health plan will aim to better integrate behavioral healthcare with physical healthcare in 2021, Nguyen shared.

“At the core of it, the partnership with providers is what makes us successful,” Nguyen emphasized.

“Having been on the provider side, it was frequently ‘us versus them.’ And we want to change that conversation. I would argue that we have very effectively changed that conversation to where, rather than having the provider versus insurance company arguing over money, it's about providers with insurance companies working together to deliver the best care to our members in a meaningful way.”