Banning: Game Changing Payment Initiative

Yesterday, Blue Cross/Blue Shield of North Carolina announced an innovative, potentially game-changing initiative, dubbed Accelerate to Value, that will provide lump sum payments to independent primary care practices to help them stay open, while transitioning practices to alternative payment models.

For months we’ve been calling on health plans and employers to embrace a Marshall Plan for Primary Care and pressed them to seize the opportunity to move primary care payment away from fee-for-service to a prospective payment model. North Carolina has a long history of innovative health care delivery and payment reform (Community Care of North Carolina was foundational in creating local organized systems of care) and are showing that entrepreneurial leadership once again.

As a proud Texan, I’m envious of North Carolina’s success and forward-looking, transformative action, but am hopeful purchasers of care (employers) and insurers in Texas will take note of what is happening in North Carolina and step up. This pandemic is far from over and independent primary care practices are and will continue to be indispensable to fighting COVID and managing  chronic and acute health care problems, yet our current payment model hampers or impedes their ability to provide that care.



Trump administration has considered ending coronavirus emergency, even as cases surge

The Trump administration, eager to claim victory over the coronavirus, has been considering scaling back the national emergency declared earlier this year to control the pandemic, according to healthcare industry officials who have spoken with the administration. The prospect has stoked alarm among public health leaders, physicians, hospital officials and others who are trying to control the outbreak and fear that such a move would make it more difficult for state and local governments and health systems to keep the coronavirus in check.

The emergency declarations the administration has issued since the beginning of the year have loosened or waived rules and regulations on hospitals and other medical providers and helped route badly needed money to states. A dramatic expansion of tele-health, for example, has been smoothed by an emergency declaration allowing Medicare and commercial health plans to reimburse clinics and hospitals for telephone and internet visits. That’s made it possible for patients to see their doctors without going to an office.

Similarly, hospitals have been able to quickly hire more staff, sometimes from other states, and to add beds without going through a lengthy permitting process. Emergency declarations also have freed additional Medicaid money for states and made it easier to ensure that people who rely on Medicaid won’t lose coverage during the economic downturn.

Source: LA Times

N.C. Blues to pay primary-care practices to stay open, join value-based care

Shelby Livingston, Modern Healthcare:

Blue Cross and Blue Shield of North Carolina on Wednesday said it plans to shore up independent primary care practices in the state and help them move into value-based payment arrangements.

There are a few strings attached: the primary care practices must attest to stay open, remain independent and commit to joining Blue Cross NC’s value-based care program by 2021, the insurer said. Starting in 2022, the practices could choose to receive capitated payments, or fixed monthly payments per patient, to care for their patients instead of being paid for each service they deliver.

The way we designed this program is to use this moment to provide relief to primary care providers, but also accelerate their movement into new payment models,” Dr. Rahul Rajkumar, Blue Cross NC’s chief medical officer, said in an interview.

Full article: Modern Healthcare