Blue Cross NC Adds Value-Based Care Program for Kidney Disease

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has launched a value-based care program for its members with kidney disease in collaboration with Fresenius Medical Care North America (FMCNA) and Strive Health.

Blue Premier Advanced Kidney Care joins the insurer’s other value-based care programs that pay doctors and hospitals for meeting quality and cost standards. Blue Premier agreements cover multiple years and build toward shared financial risk between Blue Cross NC and providers. Blue Cross NC said the program would bring the benefits of better-coordinated, high-quality care to patients with kidney disease.

“It’s important that we help our members with chronic conditions receive coordinated care, delay or prevent the need for dialysis, and improve their quality of life,” said Von Nguyen, M.D., Blue Cross NC chief medical officer, in a statement. “Advanced kidney disease has long been challenging to treat. Working with FMCNA and Strive Health, Blue Cross NC is bringing an advanced level of care to help our members who need it most.”

Blue Cross NC will collaborate with FMCNA and Strive Health to enroll eligible members at no additional member cost. Members on a commercial or Medicare Advantage plan who have chronic kidney disease stage 4 or 5 or end-stage renal disease may join. FMCNA and Strive Health will work with primary care physicians and nephrologists in the Blue Cross NC network to identify care gaps and support providers in delivering high-quality, coordinated and patient-centered care – for example, scheduling regular preventive care to ensure that patients don’t miss needed medical encounters. Members may keep their current providers. Strive Health is serving 85 counties and FMCNA is in 15 counties in the Charlotte and Wilmington areas.

Through partnerships with nephrologists and direct care arrangements, Strive manages thousands of complex CKD and ESRD patients in five states, and the company said that it would be managing, or supporting the management of more than 30,000 patients in 12 states by early 2021.

In a November 2020 interview with Healthcare Innovation, Shika Pappoe, M.D., the company’s chief medical officer, described its origins and growth.

“Strive was founded in October 2018 with the goal of creating a care model that really encompasses managing patients across the entire disease spectrum,” Pappoe said. “To date, much of kidney care has been focused around the late-stage patients, but we know the goal is to intervene early so you can slow progression and educate and empower patients to make decisions around their own care,” she added. “As much as we want to slow progression, we know there are patients who move to ESRD. Our goal is to prevent folks from crashing. Today, upwards of 80 percent of patients who transition to ESRD are actually crashing into hemodialysis. We know there are other options available to patients, including pre-emptive transplants, home dialysis and in some cases palliative or conservative care.”

Blue Cross NC said the benefits of Blue Premier Advanced Kidney Care include:
• Comprehensive member care management and disease education;
• Enhanced care coordination among primary care, nephrology and other specialties; and
• Value-based care payments based on provider accountability for total cost of care and quality performance measures (unlike traditional fee-for-service kidney care in which providers are paid on the basis of how many procedures and tests they perform).

David Pollack, president of Fresenius Health Partners, the value-based care services division of FMCNA, said its KidneyCare:365 program is designed to deliver outcomes-based care models that better align health plans and provider networks around the total health care experience for each patient. “Together with our physician partners in InterWell Health, a network of high-performing nephrologists focused on value-based care, our team will deploy proven care coordination systems and services to improve the lives of patients living with kidney disease,” he said in a statement.