Payers Continue to Expand Value-Based Contracting Despite COVID-19

June 30, 2020 - Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will financially support local independent primary care practices as they transition to value-based care during the coronavirus pandemic, the payer announced.

The payer will offer payments to providers who enter into value-based contracts based on capitated payment models.

“Collaborating with the primary care community has never been more important as this pandemic unfolds. Finding new ways for them to embrace and succeed in value-based care is an important step to better, simpler and more affordable health care for our members,” said Tunde Sotunde, MD, Blue Cross NC president and chief executive officer.

Some experts say that independent primary care practices are nearing extinction as they work with half their yearly revenue due to delayed nonurgent care. Around 50 percent of primary care practices did not know whether they would have enough cashflow to continue practicing and a fifth of those surveyed expected to close within four weeks, a Primary Care Collaborative and Larry A. Green Center survey found.

“Since the start of the pandemic, patients have cancelled or delayed their doctor’s appointments and elective procedures. More practices and patients have turned to telehealth, but virtual visits have not fully made up for the loss of income,” the Blue Cross NC press release stated.

Many expected that the coronavirus pandemic would deal a blow to the industry’s progress toward value-based care. In April, 56 percent of accountable care organizations (ACOs) in downside-risk value-based contracts through the Medicare Shared Savings Program (MSSP) said that coronavirus-related financial struggles might drive them out of the MSSP.

But some payer-provider partnerships have not given up on the value-based care model. Blue Cross NC and others have been transitioning their networks into a value-based care model in an effort to keep primary practices alive.

Blue Cross NC’s Accelerate to Value is a value-based care program that offers financial support for practices as they move into value-based care.

Providers could apply starting the week of June 22, 2020. The payer will begin making payments to participating providers by September 2020, in accordance with their revenue from 2019.

Meanwhile, the providers will either join an accountable care organization (ACO) in Blue Premier, the payer’s value-based care program, or in Aledade, a company with which multiple major payers have partnered to transition provider networks into value-based care.

Beyond joining a Blue Premier or Aledade ACO, the providers will agree to enter into a capitated payment model with Blue Cross NC. Under this model, the payer will give the provider a fixed monthly payment based on patient outcomes, as opposed to a fee-for-service payment for each individual service.

Specifically, Blue Cross NC will be looking for quality improvements such as

• Access to care
• Telehealth access
• EHR usage
• Preventive care
• Care coordination

If providers can meet these standards, Blue Cross NC will extend a value-based contracting amendment to them.

“Primary care providers across North Carolina are in a financial crisis. We have a duty and a desire to act,” said Rahul Rajkumar, MD, Blue Cross NC senior vice president and chief medical officer. “We’re here for primary care providers. Accelerate to Value will help them stay in business and improve their ability to provide the highest quality care to Blue Cross NC members and all of their patients.”

Blue Cross NC is not the only one making this shift during the coronavirus pandemic.

Geisinger Health Plan also recently announced a value-based contract with a provider. For the payer, this partnership will enable better preventive care and chronic disease management options for Geisinger Health Plan members. The partnership is just another step toward transforming the entire network into a value-based care model, the payer indicated.