News: CJ Exclusives

BCBSNC partners with companies to open clinics for Medicaid patients

North Carolina’s largest insurer has brokered an agreement with three national health care companies to open intensive primary care clinics this year in areas lacking services.

“When patients with multiple health issues have access to intensive primary care, we know they’re more satisfied, and we know it improves their overall quality of care, and reduces total cost of care,” Dr. Rahul Rajkumar, chief medical officer of Blue Cross and Blue Shield of North Carolina, said  in a press release Friday.

The companies’ operations mirror the shift among the state’s hospitals and doctor groups. Quality of care is emphasized rather than the amount of services delivered. Primary care physicians coordinate patients’ care. Providers get a limited amount of money to provide necessary clinical services. Key goals include addressing lifestyle and other social factors which can harm a patient’s health.

The state Department of Health and Human Services is shifting toward that delivery model for most of its 2.1 million Medicaid recipients. The change — required by state law — will occur in phases, with the first one launching Nov. 1 for 1.6 million people.

Starting next year, Cityblock, headquartered in New York City and spun off from Sidewalk Labs, a company under Google parent Alphabet; California-based CareMore Health; and Boston-based Iora Primary Care will treat Blue Cross NC Medicare Advantage patients. They also will treat recipients of other Medicare and Medicaid plans.

BCBSNC won a DHHS contract to set up a statewide managed care network under the Medicaid reorganization. That could position the new practices to participate in the state’s Medicaid transformation, or in Medicaid expansion if it occurs.

The companies embrace some of the goals that direct primary care doctors embed in their practices. Direct care doctors give patients more face time during medical visits by restricting case loads, although most don’t accept insurance. Under the BCBSNC plan, a team of doctors will share patient care, thus opening up more time.

Kyle Marshall, BCBSNC spokesman, told Carolina Journal locations of the new physician practices are still being discussed. Several locations are expected to open in the Triangle, Triad, Charlotte, Fayetteville, and Asheville areas.

Those offices would care for underserved patients. But Marshall said it’s not clear how far outside those cities the offices would operate. Some of the state’s most pressing medical needs are in rural areas.

“Generally, we expect them to recruit from local physicians in each region that might be interested in working in this type of practice setting,” Marshall said.

BCBSNC may invest directly in one of the three companies, but wouldn’t be able to disclose any terms, Marshall said.

CareMore Health is an Anthem Blue Cross company.

Under the contracts, BCBSNC will pay providers fixed fees in advance to offer a wide range of services to patients. In turn, the providers are held financially accountable for patient outcomes and total health care costs.

Marshall said he can’t project cost savings from the deal.

Fast Company business magazine ran a short profile of Iora Health. The profile cited a 40 percent reduction in hospitalizations and 20 percent dip in emergency room visits at its clinics.

Consistently keeping patients out of costlier settings when possible has eluded health care reformers.

Marshall said those results shouldn’t be used as an expectation for North Carolina.