How Payers Can Overcome Provider Barriers in Value-Based Care
Providers face many barriers when considering whether to transition to value-based care and payers can be the key to resolution by communicating, offering data, and trusting providers.
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- In 2019, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) made a big change.
That year, the company launched its value-based care program Blue Premier in an effort to ensure that every member was covered under a value-based contract. In 2019, Blue Cross NC had five systems engaged in Blue Premier.
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In the years since the program started, Blue Premier has grown significantly. More than 870 independent physicians and eleven hospitals and health systems are engaged in multiyear value-based contracts through Blue Premier.
Although the program expanded quickly, it was by no means easy, Troy Smith, vice president of cost of care and value programs at Blue Cross NC, explained in a Healthcare Strategies episode.
“We try to get as many members as possible into risk-based arrangements across all segments,” Smith said. “Some payers may only do it for ACA, or Medicaid, or Medicare Advantage, but we really try to have a full stack of all of our membership in the reimbursement program.”
To achieve that goal, Blue Premier had to help all of the relevant stakeholders get acclimated to a new way of reimbursing care.
Smith and his colleagues found that providers agreed with the concept of value-based care. They wanted to see quality of care improve for their patients. But one of the primary barriers to joining a value-based contract lay in working out the details of those contracts: how to calculate quality, implement solutions, and report on quality measures.
Additionally, many providers lacked the tools to engage in risk-based contracting. They may not have insight regarding areas for quality improvement.
Payers are in the position to address both of these barriers as they partner with providers to increase the prevalence of value-based care contracts, said Smith.
Blue Cross NC brought actuarial firms to their accountable care organization partners to explain how the quality measurement calculations work. The payer also established provider engagement teams that work closely with the accountable care organizations to continue assessing savings opportunities, offer the context of other providers’ performance, and more.
“It comes down to having shared goals, having shared communication patterns—like I've been talking about with reporting and provider engagement,” Smith shared. “And then we trust them to turn around and produce those savings over time.”
