“Finally we are getting the credit we deserve."

That was the reaction from Vivian Leftwich, practice manager in the office of Dr. Challie Minton, a family physician and U.S. military veteran who has been serving the rural county of Surry, NC since 2009. 

Vivian had just heard the results from the first performance year of our ACO contract with Blue Cross North Carolina. In 2019 alone, 47 independent primary care practices with 102 locations across the state had collectively generated 4.7% savings below the benchmark for the Blue Cross commercial population, and 6.1% savings for the Medicare Advantage population, while achieving the maximal commercial quality bonus and improving our MA STARS score from 3.0 to 4.5 out of 5. In other words, these practices had helped bring down health care costs while improving the quality of care for tens of thousands of North Carolinians.  

And by being part of an ACO, they received a vital financial lifeline for doing so. These practices earned more than $10 Million in shared savings payments and quality bonuses, and in the words of Dr. Rahul Rajkumar, CMO of BCBSNC, made the Aledade ACO “among the highest-performing health systems in the state.” 

“Finally.”

North Carolina’s independent primary care practices are not new to the goals of quality improvement and cost containment. Many of these practices have been at the frontier of attempts to innovate care delivery and improve population health for 20 years. Through grassroots collaboration and the mission-driven efforts of organizations like NC DHHS Office of Rural Health, Community Care of North Carolina, and NC Area Health Education Centers they have been immersed in in a dizzying alphabet soup of initiatives to “demonstrate their value” over the years: accreditation programs (PCMH, HSRP, DRP); private foundation and agency grants (IPIP, HHN); federal demonstrations (CHIPRA, MAPCP, 646, Beacon, TCPI PTN); public and private payer initiatives (MU, PQRI, MIPS, BQPP, QPIP). What has been missing? A business model that actually, meaningfully, rewards the value of primary care!

The value of primary care is rooted in continuous, long term relationships — with patients and families and with the community — that facilitate access, assure continuity, and coordinate care of the whole person. The financial return for investing in primary care accrues through people being healthier: prevention and early detection of illness; better management of chronic conditions; less fragmented and duplicative services; fewer hospital visits. Payer programs that emphasize discrete sets of narrowly focused metrics barely nibble at the edges of capturing this value. It is only through accountable care contracts that put the downstream savings generated by primary care back into the hands of primary care practices that we can finally, in Vivian’s words, begin to “get the credit we deserve.” 

How They Did It

 diabetes have poor blood sugar control” and feeling paralyzed by the familiar frustration that “the data must be wrong,” they heard “here’s how we are going to get more accurate information over to the payer in a way that is not a hassle for your team.” And with reliable information now in hand, “here are the patients who need to be reached out to for more support.”   

In less than 6 months, these practices improved medication adherence, diabetes A1C control and attention to nephropathy, medication reconciliation after hospital discharge, BMI assessment, colorectal cancer screening, and management of rheumatoid arthritis.  

And the shift from reactive to proactive care was not limited to Blue Cross NC patients. Our 2019 performance in ACO contracts with MSSP and United also demonstrated excellent quality and substantial cost savings, which means additional financial relief is on the way once those results are finalized and savings paid. Regardless of the payer, the percent of Medicare patients who were up to date with their Annual Wellness Visit grew to 65% by the end of 2019.  Patients are more and more likely to receive transitional care support after a hospital discharge, a check-in call after an emergency room visit, and outreach to assure they have what they need to stay well at home during the pandemic.    

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Aledade is now partnering with 138 independent primary care practices with 256 practice locations across North Carolina, and we are excited to extend this model to include independent pediatric practices in 2021.  

This growth is fueled in part by having Blue Cross NC as a payer partner who fully grasps the importance of independent primary care in the healthcare market, and is willing to recognize — and pay for — the true value of primary care. Dr. John Scheitler of Piedmont Adult and Pediatric Medical Associates in Gastonia, NC said it well when he said, “This is the first time in all my years of practice that I have ever thought of a payer as a partner.”  

We’re fortunate to have found such a payer in Blue Cross North Carolina. We need more of that commitment from all payers across the country, but in North Carolina, we’re off to a fantastic start!