Blue Cross NC, Caravan to Launch ACO for Rural Providers

Blue Cross and Blue Shield of North Carolina is working with Caravan Health to launch  a new accountable care organization (ACO) in January 2021 that will work with community and rural hospitals.

The ACO will enable more North Carolina health systems to collaborate with Blue Cross NC and Caravan as part of Blue Premier, Blue Cross NC’s value-based care program. Under Blue Premier, participating providers and Blue Cross NC are jointly accountable for meeting quality and cost measures.

The companies said the new ACO would help providers better manage and treat chronic conditions, share in the cost savings through value-based care, and move to a more sustainable financial model than traditional fee-for-service healthcare.

“Extending value-based care through Blue Premier is an important next step in supporting community and rural hospitals, especially as the pandemic has exposed the flaws of fee-for-service,” said Von Nguyen, M.D., who recently replaced Rahul Rajkumar, M.D., as Blue Cross NC chief medical officer, in a statement. “Caravan Health will be an essential part of making the benefits of value-based care available to more Blue Cross NC members through access to better, more affordable care.”

Blue Cross NC noted that community and rural providers have seen challenges in adopting value-based care because the smaller population and gaps in technology can make it difficult to achieve the scale needed to show quality improvements and cost reductions. In North Carolina, with an estimated 28 percent of the state’s population living in areas deemed rural by the U.S. Census Bureau, many residents face shortages of medical providers in their communities. About 26 percent of the providers in Blue Cross NC’s network are in rural areas.

The ACO from Blue Cross NC and Kansas City-based Caravan will seek to address these challenges. Providers will have access to Caravan’s methodologies and resources to help them measure and improve quality. These resources include enhanced data analytics, patient engagement technologies and accountability tools, and on-the-ground support from a regional team. In North Carolina, providers in the Blue Premier ACO will mitigate their risk through Caravan’s risk-sharing solution, which focuses on practice transformation and achieving quality goals.

Blue Premier agreements cover multiple years and build toward shared financial risk between Blue Cross NC and providers. Eight of North Carolina’s largest health systems, plus more than 200 independent primary care practices, already are in Blue Premier. Providers in Blue Premier collaborated with Blue Cross NC to generate an estimated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on healthcare in 2019, the program’s first year, the organization said.