North Carolina eyes healthcare payment reform: 6 things to know

North Carolina has embarked on its journey to have physicians and hospitals paid based on health outcomes instead of volume, according to The New York Times.

Six things to know about the project:

1. The transformation efforts are prompted by similar priorities of the North Carolina Department of Health and Human Services and Blue Cross Blue Shield of North Carolina.

2. Both agencies said they are pursuing aggressive shifts from fee-for-service to value-based payments. The two are the state's biggest payers, and each is led by a former official in former President Barack Obama's administration.

3. Primary care continues to be a significant part of North Carolina's healthcare transformation efforts. According to the Times, Ardmore Family Practice in Winston-Salem and other primary care clinics will put even more focus on care management long term as part of the transformation. For instance, at Ardmore, patients are asked questions about social determinants of health such as food and housing. Physicians also talk more with patients during wellness visits and receive higher reimbursement as a result, the newspaper reported.

4. Overall, health policy experts estimated that the portion of healthcare spending for primary care physicians will jump from 6 percent to 8 percent to 10 percent to 13 percent over several years under North Carolina's healthcare transformation.

5. The Times reported that some primary care clinics, including Ardmore, also will form an accountable care organization as part of North Carolina's project, with reimbursement tied to health outcomes of the patient populations they serve.

6. Blue Cross Blue Shield of North Carolina this year signed value-based contracts with five of North Carolina's largest health systems, including Durham-based Duke University Health System.

Access the full Times report here.


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