BCBS of NC and Cornerstone Health Care Form ACO

Cornerstone Health Care and Blue Cross Blue Shield of North Carolina, the largest health insurer in the state, have partnered to form an accountable care organization that will tie reimbursement for care more closely to hitting quality measures.

The partnership is a final piece of High Point-based Cornerstone’s puzzle in moving toward “value-based” contracting and away from strictly fee-for-service reimbursements that pay solely based on the quantity of services delivered. During the last year, Cornerstone has formed accountable care organizations with UnitedHealthcare, Cigna, Aetna and Coventry Health Care of the Carolinas.

The new accountable care organization will become effective for Blue Cross Blue Shield enrollees that use Cornerstone providers on May 1, and is the fourth such organization Blue Cross Blue Shield has formed with providers.

“Working with Cornerstone gives us the opportunity to build on a model of care that provides better coordination and health outcomes for our customers,” said Lisa Cade, vice president of network management at Blue Cross Blue Shield.

The agreement centers around a more coordinated, team-based approach to delivering care that works more closely with patients suffering from chronic health conditions, such as diabetes or heart disease, while delivering a more coordinated program of care to all patients.

Health navigators and patient care advocates are put in place to help patients better keep up with their care and tap into wellness and prevention resources, with providers sharing in cost savings generated from delivering higher quality care and keeping patients healthier.

“This approach focuses on the whole patient with a team that includes doctors, nutritionists, health coaches and social workers,” said Dr. Grace Terrell, president and CEO of Cornerstone. “It will increase patient engagement and ensure patients are receiving appropriate care and screenings. Our goal is to achieve better health outcomes and to prevent more costly treatments or hospitalizations for our patients.”

Cornerstone is the largest independent physician practice in the Triad, with 116 locations and more than 350 providers in the Triad and western Piedmont. Blue Cross Blue Shield has more than 3.7 million members statewide.

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Retrieved From:
May 3rd, 2013