In an attempt to catch the health care golden goose of better health outcomes at a lower cost, the state’s largest health insurer joined a large Wake County Accountable Care Organization.
Blue Cross and Blue Shield of North Carolina has signed on with WakeMed Key Community Care, an ACO in Wake County that includes WakeMed Health & Hospitals, WakeMed Physician Practices and Key Physicians, the largest network of independent primary care physicians in the Triangle. With this agreement, BCBSNC and WKCC will establish a Joint Quality Committee, responsible for achieving high quality measures that focus on prevention, chronic conditions, inpatient quality and patient satisfaction.
These ACOs are a result of the Affordable Care Act and are a network of health care providers who try to coordinate care better amongst themselves. Ideally, this will reduce duplicate or unnecessary services and allow doctors to deliver the right care at the right time at a lower cost. Uncoordinated care can lead to unnecessary or duplicate tests. America’s Health Insurance Plans, the health insurance lobby, estimates that one in five hospital radiology tests are duplicates, wasting $20 billion per year. That’s just one example of several unnecessary tests, according to many health care experts.
Through the new agreement with BCBSNC, WKCC will work together to help patients better manage their health. Blue Cross said it established a financial structure that focuses on paying for the value of health care – including quality and efficiency – not simply volume of care.
“Health care will continue to evolve and our collaboration with WakeMed Key Community Care is just one example of how we can all work together across the health care industry to focus on the value, not volume, of health care services,” said Dr. Susan Weaver, chief medical officer of BCBSNC. “Our goal at BCBSNC is to continue to create innovative relationships with providers that shift the focus of care to high quality outcomes at a more affordable cost while enhancing the experience for our customers.”
Patients do not need to enroll or sign up. Current and new BCBSNC customers who are patients of WakeMed Health & Hospitals, WakeMed Physician Practices and Key Physicians will automatically benefit from enhanced coordination of their care through the ACO. Insurance benefits stay the same whether or not a patient’s physician participates in an ACO.
Date: July 22, 2014