N.C. Blues will pay primary-care docs to stay open, adopt value-based care
Blue Cross and Blue Shield of North Carolina said it plans to shore up independent primary-care practices in the state and help them move into valuebased payment arrangements.
The Blues insurer said it would make lump-sum payments to participating primary-care practices in 2020 and 2021 to help them weather the COVID-19 pandemic, which has drained many providers of income and prompted some to close their doors. Those payments would be based on 2019 revenue and begin by September.
There are a few strings attached: The primary-care practices must attest to stay open, remain independent and commit to joining the Blues plan’s value-based care program by 2021, the insurer said. Starting in 2022, the practices could choose to receive capitated payments 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,” said Dr. Rahul Rajkumar, Blue Cross NC’s senior vice president and chief medical officer.
In the past several months, healthcare providers of all types have lost money as they deferred non-urgent procedures and patients canceled routine doctor’s visits amid the COVID pandemic. Primary-care practices, many of which operate on thin margins and lack large reserves, have been especially vulnerable. Rajkumar said about half of North Carolina’s primary-care practices are independently owned and operated.
A growing number of insurers are helping providers stay open during the COVID crisis. Buffalo, N.Y.-based Independent Health increased its payments to primarycare practices to help them maintain a monthly cash flow similar to pre-pandemic levels. California insurer Inland Empire Health Plan also moved to fill gaps in hospitals’ and specialists’ revenue. Other insurers have offered providers loans, advanced payments or sped up claims payments.
Under the initiative, dubbed Accelerate to Value, Rajkumar said Blue Cross NC will compare primary-care practices’ revenue in 2020 with their average revenue in 2019 and make a lump-sum payment to fill the gap. It will do the same thing in 2021. It will not recoup any excess payments that may occur. Participating practices would be required to join an existing accountable care organization in the insurer’s value-based care program, Blue Premier, or join one run by Aledade, a company that assists with running ACOs.
The Blues plan’s value-based program holds physicians accountable for the total cost and quality of care through upside and downside risk. The plan hopes that primarycare practices will eventually opt to accept capitated payments, which Rajkumar said would allow “primary-care practices to serve their patients in the best way possible.”
Anecdotal evidence suggests that providers participating in value-based arrangements, and especially those that provide a predictable source of income like capitation, were having an easier time staying afloat during the pandemic than physicians relying on fee-for-service income.
“We’d have a stronger primary-care system that is better supported in managing public health challenges like COVID-19” if more practices were already involved in such value-based payment models, Dr. Mark McClellan, former CMS administrator and Food and Drug Administration commissioner who is director of the Duke-Margolis Center for Health Policy at Duke University, wrote in an email. ●