Primary Care Progress

Investing In Primary Care, Investing In Health

Primary care's future is looking brighter now that forward-thinking payers are putting their money on it as a means to lower costs and improve health. Here, Brad Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina, tells us why the state's largest insurer is investing in primary care.

By Brad Wilson, President, CEO
Blue Cross and Blue Shield of N.C.

It may surprise you to hear that as an insurer, primary care is a top priority for Blue Cross and Blue Shield of North Carolina (BCBSNC). Think about it: our customers count on us to deliver products that will help them stay healthy and protect their families from financial ruin. And there’s no better way to achieve those goals than by promoting effective primary care. Consider this: our health care system wasted one out of every three dollars spent on health care last year on things like duplicate tests, and up to 27 percent of emergency room visits are not for actual emergencies. These are everyday problems that can be solved with more effective, coordinated primary care.

In order to tackle these challenges, we joined Dr. Bill Roper and his team at UNC Health Care in 2011 to build a new primary care practice from the ground up. Our goal was to use what we’ve learned from the proven success of the Patient Centered Medical Home (PCMH) model and take it to the next level to exceed patients’ expectations by improving their health and reining in overall health care costs. The new practice, Carolina Advanced Health, which is owned jointly by UNC Health Care and BCBSNC, allows patients to see not only their doctor, but also a pharmacist, nutritionist and care manager all in the same visit, and under the same roof. Patients can also find mental health, medication management, and lab services right on site. This not only adds convenience for our customers and patients, but also can help them adhere more closely to their treatment plans. And a BCBSNC customer service professional works on site ready to answer our customers’ questions about their coverage or claims.

From the beginning, we knew success would depend on some key assumptions. Taking a team approach, we’d emphasize patient involvement and allow more time for clinical interaction, patient education and support. We’d also improve quality, reduce total medical expenses, increase patient and provider satisfaction, and identify key practice concepts that could be replicated across the state. And we’d acknowledge that we do not have all the answers. This new practice would foster a “learning lab” atmosphere to continue to improve on the patient experience.

Carolina Advanced Health just celebrated its first birthday, and it continues to grow and teach us new things every day. Dr. Sarah Smithson, a member of the talented team, discusses some of these findings in her recent post. And every day, we hear from patients who say they have never experienced more convenient, personalized care. “Why aren’t all doctors’ offices like this?” they ask. From an innovation perspective, the information we’re gathering about what works, what doesn’t and what we need more of – and less of – in health care, is most exciting. It’s these discoveries that hold the keys to the future of health care delivery.

When it comes down to it, it’s time that we recognize that the goals of physicians, hospitals, and insurers are quickly becoming one in the same: better health for our patients and customers. And when patients are healthier, health care costs are lower and everybody wins. The sooner we all recognize this, the sooner we can work on new partnerships that make health care better for everyone.

Brad Wilson is CEO of Blue Cross and Blue Shield of North Carolina, the state’s largest insurer. Wilson works with the Council for Affordable Healthcare Quality and the National Institute for Health Care Management to address health care challenges at the national level, among other appointments.

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Posted by Sonya Collins on Feb 12, 2013 11:22 AM US/Eastern

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Brad Wilson

Date Posted: Mar 5, 2013 at 1:57 PM

Thanks for your thoughts, Andrew. I like your idea of insurers being considered a part of the primary care team. In order to move forward together, we have to transition away from fee-for-service models. One example of how BCBSNC is already doing this is our Blue Quality Physicians Program that provides incentive payments to community-based primary care doctors who meet higher quality standards. Our quality team at Blue Cross consults with these practices daily to help them meet national quality standards so they can get needed resources to provide those higher levels of care. We have also fully implemented alternative payment methods like flat-fee arrangements, with doctors earning a guaranteed payment for knee surgeries – from diagnostic visits to the procedure itself all the way through follow-up care. Reforming the health care system will take some experimentation and some risk from providers and payers to arrive at a system that pays for quality of care instead of quantity of procedures.

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Andrew Morris-Singer

Date Posted: Feb 19, 2013 at 8:17 PM

Brad, thanks for this great piece. If there is one thing that I believe in every bone in my body, it’s that we’re never going to fix primary care unless we mobilize all members of the primary care team, and leverage their resources, interests and power in that effort. So to have insurers and other “payers” finally on the primary care team, speaking out not only in favor of more robust primary care, but also identifying what they’re no longer interested in paying for (late “sick care”)….it just warms my heart. As more and more clinicians and care teams around the nation realize that we have more in common with payers than we previously thought, we’ll harness these opportunities, build collaborations, advance new models of care delivery and provide those practices with the financial support they need to deliver on the promise of a new style of delivery.

That being said, one thing I hear frequently when I’m on the road these days visiting sites where the new patient-centered, team-based model of primary care delivery has taken root, is that it feels to many of these front line clinicians that they’re being asked and expected to deliver a higher value primary care service, but they’re not being financially supported in those efforts. Said differently, the financial incentives that they still operate under, continue to discourage the types of models that you and I both care so deeply about. This is something we need to fix, and fix quickly. As long as Fee For Service continues to dominate our payment system and clinicians operate in a largely productivity-based framework, we’re effectively being discouraged from replacing face-to-face visits with telephone encounters and email visits, and we’re being discouraged from asking other non-MD members of the care team to take on certain patient care responsibilities traditionally on the MDs plate.

If we’re asking the primary care community to step up, we need to support them fully. And part of that is about adding financial incentivizes to encourage us to do the right stuff (ie new monthly payments for care coordination). But the other part is removing those financial disincentives that discourage us from making any of these changes in the first place.

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