August 28, 2019

This state is making 'the biggest bet yet' on value-based care

Daily Briefing

    North Carolina and its largest private insurer have recently launched initiatives to move away from a fee-for-service model, toward value-based care, and several of the initiatives are showing early signs of success, Steve Lohr reports for the New York Times.

    What roles do you need on your primary care team to advance value-based care?

    The 'biggest bet yet'

    Leading the move toward value-based care are the state Department of Health and Human Services, which oversees Medicaid payments, and Blue Cross Blue Shield of North Carolina, the biggest private insurer in the state. Combined, the two entities cover two-thirds of North Carolina's insured population, according to Lohr. The two entities didn't formally coordinate their efforts but rather launched them both around the same time, Lohr reports.

    While the idea of moving from fee-for-service to value-based care isn't novel, North Carolina's project is "is the biggest bet yet on the concept," Lohr writes.

    An emphasis on primary care

    One of the changes under way in North Carolina is a greater emphasis on primary care.

    Mandy Cohen, the secretary of the state's health department, said, "I want to buy health with our dollars, not necessarily buy health care."

    Namely, the state has launched a payment model that pushes primary care providers to make systematic changes to know their patients better. Those efforts include asking patients questions about depression, alcohol consumption, food, and housing, Lohr writes.

    As a result of the state's changes, primary care physicians are likely to see the share of total health care dollars coming their way increase from about 6-8% to 10-13% over several years, according to estimates from health policy experts.

    The change also encourages primary care clinics to form ACOs, which allows the clinics to share training and technology programs, as well as patient populations that will determine their reimbursement, Lohr writes.

    Similarly, earlier this year Blue Cross announced it signed five of the largest health systems in North Carolina to state contracts that link their payments to total costs of care for patient populations, as well as quality measurements, Lohr writes.

    These new contracts will set a monthly fee to pay providers per patient, and allow the providers to largely determine how to spend and save that money. According to Thomas Owens, president of Duke University Hospital, this could open up new relationships with payers, as there won't be anymore fighting over approving each test and treatment.

    Robert Rosen, a physician at Ardmore Family Practice in Winston-Salem, said the state's initiative holds "a lot of promise."

    Amy Sapp, another physician at the practice, said the initiative makes "tremendous sense," but worried that "it becomes this year's box to check, another bureaucracy that sits on top of everything else."

    A focus on social determinants of health

    North Carolina is also focusing on social determinants of health in a major way, Lohr writes. The Trump administration approved the state's plan to spend $650 million in state and federal funds on pilot projects to address social determinants.

    In one program in Greensboro, researchers identified 41 families with children who made frequent visits to the hospital for asthma. They visited these children's homes and identified potential asthma triggers, like mold or dusty carpeting, and then made recommendations and repairs. After that, hospital costs related to asthma for those children dropped by more than half, Lohr writes.

    Kathy Colville, health communities director at Cone Health, which participated in the asthma program, said, "The future is trying to do that across the system, not just for a few dozen families."

    The state also launched NCCARE360, a free online service that connects public health departments with providers who can make referrals online to service organizations and people in need, Lohr writes. The service also directs patients to services near them, such as food pantries and homeless shelters, and can help health departments and providers track whether people they've referred to those services actually visited them, Lohr writes.

    So far, the service has been introduced in just 15 of the state's 100 counties, but statewide coverage is expected by the end of 2020.

    Stacie Saunders, director of public health at the Alamance County Health Department, said the services "could be a game-changer instead of just sending people out of here with a brochure."

    Blue Cross has also recently started sharing claims information with providers, who will share clinical data with Blue Cross, Lohr writes. This data will fuel data analysis software that identifies the patients most in need of care or counseling (Lohr, New York Times, 8/26).

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