Sunday, June 23, 2024

Blues clues: What Mission Health’s new Blue Cross NC plans mean

Asheville’s Mission Hospital and the other hospitals and medical practices in Mission Health’s 20-county western North Carolina territory are adding Blue Cross Blue Shield of North Carolina’s Blue Premier and Healthy Blue care programs. The move gives patients at the state’s sixth-largest health care system access to “value-based care” and “managed-care” plans.

Healthy Blue, one of five state-approved Medicaid options, takes effect July 1, while Mission’s Blue Premier value-based care program starts in January. Including Mission Health, Blue Cross has Blue Premier approved at eight of the state’s 10 largest health systems — Atrium, Cone, Duke, Mission, Novant, UNC, Wake Forest and WakeMed.  

Blue Cross estimates that in Blue Premier’s first year of availability in N.C., it generated an estimated $159 million in cost savings.That total was derived by medical practices meeting their performance goals of providing high-quality and cost-effective care for 536,000 plan members. 

Value-based care means providers are paid for quality, cost-effective care, not the number of procedures they do or tests they administer. Providers are paid based on patient health outcomes, helping patients improve their health and reducing incidences of chronic disease. It differs from a pay-for-service method, in which doctors or providers are paid for the amount of services they prescribe. 

“Blue Premier isn’t a plan with specific benefits but a program that extends across most of our lines of business,” spokesperson Kyle Marshall says. “Blue Premier agreements don’t have a direct impact on Blue Cross revenues. The impact is on the cost and quality of care that we and our customers pay for. Blue Premier encourages providers to collaborate with us to improve quality and reduce costs. It includes incentives for doctors and hospitals to meet agreed-upon quality and cost metrics.”

For example, statewide in 2019, Blue Premier systems tallied 13,412 more cases of controlled blood pressure than in 2018, meaning many heart attacks and strokes may have been prevented.

Mission Health’s participation in Blue Premier continues “Mission’s commitment to quality, cost-effective care.” spokesperson Nancy Lindell says. “Mission Health, Mission Health Partners and Blue Cross will share enhanced data that supports quality outcomes while working to better integrate care.”

Blue Premier member systems account for 65% of Blue Cross’ annual spending on hospital care. “Blue Premier agreements cover multiple years and build toward shared financial risk between Blue Cross NC and providers, which sets the program apart from other value-based care arrangements,” the company says.

Mission Health, which HCA Healthcare acquired for $1.5 billion in March 2018, has hospitals in Brevard, Franklin, Highlands, Marion and Spruce Pine.

The Blue Cross agreement isn’t Mission’s only recent insurance deal. Last November, Mission Health entered agreements with Bright Health, UnitedHealthcare Exchange Plans, Cigna Connect and Oscar Health, which offer family and individual plans through the Affordable Care Act.

As for Healthy Blue, Blue Cross and five other groups have been approved by the state to offer Medicaid managed-care services. They include AmeriHealth Caritas, UnitedHealthcare, WellCare, Carolina Complete Health and Eastern Band of Cherokee Indians Tribal Option.

Managed care means the state pays prepaid health plans a set, monthly amount to manage the care of its members. Previously, Medicaid paid doctors, hospitals and other providers for each patient visit, test or procedure. The 1.6 million people who use Medicaid for their health care, pharmacy benefits and behavioral health services were to have enrolled in a “managed care” plan by May 14, or be assigned one by the state by May 15. The plans will launch July 1. 

Blue Cross says Healthy Blue members are eligible for rides to medical appointments, up to $200 to use toward asthma relief products, $75 in annual “rewards” for visiting a doctor, $50 in online catalogue school supplies and $120 for fresh fruits and vegetables. The state has 48,000 providers who accept Healthy Blue, including hospitals, rural health centers, local health departments, group practices and behavioral health specialists.

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