Available Payer Programs

The Medicare Shared Savings Program (MSSP) was established to improve the quality of care for Medicare Fee-For-Service beneficiaries by promoting accountability for the care of Medicare FFS beneficiaries, requiring coordinated care for any service provided under Medicare FFS, and encouraging investment in infrastructure and redesigned care processes. MSSP also aims to reduce unnecessary costs. Providers, hospitals and suppliers that either create or participate in an Accountable Care Organization (ACO) may participate in this program. Those ACOs that lower their rising health care costs and simultaneously put patients first and meet performance standards on quality of care will be rewarded by the Medicare Shared Savings Program (MSSP).

Click here to learn more about MSSP.

Blue Cross Blue Shield of North Carolina: Blue Cross and Blue Shield of North Carolina (BCBSNC) works closely with providers and patients to achieve high-quality and high-value care while reducing the need for high-cost medical services. Over the past few years, BCBSNC has launched a number of value-based programs that have established innovative payment mechanisms, administrative structures, and care delivery models that seek to improve health outcomes and patient satisfaction while lowering medical costs.

BCBSNC has piloted bundled payments for major surgeries, improved patient-centered medical homes and increased cost transparency across the health care system. The payer has also developed incentive programs that reward specialists, primary care physicians, and hospital systems for patient-centered care, clinical quality and cost efficiency. In addition, BCBSNC has formed several Accountable Care Organizations (ACO) with independent doctors and health systems to provide high quality, highly-coordinated and more efficient care for patients.

To coordinate these programs, BCBSNC has developed robust analytic capability and is collaborating with providers to securely share valuable data and resources.

“BCBSNC is committed to finding new ways to improve quality, enhance the patient experience and reduce unnecessary medical expense,” said Dr. Susan Weaver, M.D., BCBSNC vice president of health delivery redesign. “We’re excited to work with our provider partners on projects that can impact the quality of health care for all North Carolinians.”

Press releases for BCBSNC Value-based Programs
April 2014: BCBSNC and Wake Forest Baptist Medical Center Launch New Center for Healthcare Innovation

Sept 2013: New Hanover Regional Medical Center, Wilmington Health and BCBSNC Launch NC’s First Accountable Care Alliance

August 2013: BCBSNC and Key Physicians Team Up to Create a Better Patient Experience

April 2013: BCBSNC and Cornerstone Health Care collaborate to enhance patient experience, improve health through ACO

Dec 2012: BCBSNC and Cape Fear Valley Health System to Launch New ACO Collaboration

July 2012: BCBSNC and Wilmington Health Launch ACO to Benefit Southeastern North Carolina Patients

Aetna: “Value-based, patient-centered care models, including accountable care organizations (ACOs), are an important component of Aetna’s vision for a more connected and effective health care system. We believe that together with providers, we will help drive much-needed change to the quality, delivery and cost of health care in America.” More…

CIGNA: “Cigna is now engaged in 86 collaborative accountable care initiatives in 27 states. These programs encompass more than 880,000 commercial customers and more than 35,000 doctors, including more than 16,000 primary care physicians and more than 19,000 specialists. Cigna launched its first CAC program in 2008. We will achieve our goal to have 100 of them reaching one million customers in 2014…. Collaborative accountable care is one component of the company’s approach to physician engagement for health improvement, which also includes the innovative Cigna-HealthSpring^SM care model for Medicare customers. Today, well over one million Cigna and Cigna-HealthSpring customers benefit from more than 250 engaged physician relationships across 31 states, with more than 62,000 doctors participating, including more than 22,000 primary care physicians and more than 40,000 specialists.” More…

In North Carolina, the following health systems have formed accountable care relationships with Cigna:

• Boice-Willis Clinic
  Effective Oct. 1, 2013. Press release.
• CaroMont Medical Group
  Effective July 1, 2013. Press Release.
• Cornerstone Health Care
  Effective April 1, 2012. Press release.
• Key Physicians
  Effective April 1, 2012. Press release.
• Novant Health
  Effective April 1, 2013. Press release.

United Health Care: “UnitedHealthcare is evaluating a variety of value-based contracting strategies to increase quality, reduce medical costs, improve patient outcomes and share risk as well as responsibility for controlling medical cost trend. More…In North Carolina, the following health systems have formed accountable care relationships with United:

• Cornerstone Health Care
  Press release.