We work continuously to make our health plans more affordable for our members and customers.
4.5 Stars for Our Medicare Advantage Plans
Blue Cross NC’s Medicare Advantage plans demonstrate high performance, ranging from clinical operations to customer service and member experience. The Centers for Medicare and Medicaid Services (CMS), a federal government agency, rates how well Medicare health plans take care of their members every year. Blue Cross NC’s Medicare Advantage HMO and PPO plans’ score of 4.5 out of 5 Stars indicates an “excellent” rating. Please visit medicare.gov for more information about Star ratings. more...
This high score shows that we’re doing well in the six categories that CMS considers for ratings:
- Staying healthy: Screenings, tests and vaccines
- Managing chronic (long-term) conditions
- Plan responsiveness and care
- Member complaints, problems getting services and choosing to leave the plan
- Health plan customer service
- How well the plan helps members use recommended and safe prescription medications
Through the combined efforts from people and teams throughout our organization, we steadily improved from 3.5 stars to 4.5 stars over the past three rating years. Better Star ratings result in greater reimbursements for us, which we pour into improving benefits and affordability for our members.
One focus in 2021 was ensuring that members didn’t miss a dose of their medications. This involves working with pharmacies and health care providers to make sure members receive their prescriptions on time, ensuring that the prescriptions members need are covered and affordable and helping members understand when and how to take their medicines properly.
We are proud of how well we scored with customer service, but we’re always trying to improve. In 2021, we added a Spanish version of our Medicare website. We also added a second translation services vendor to expand our support for members who speak languages other than English.
As we move into the future, we will continue striving to make it easier for our members to access high quality, affordable care. This is essential to our company’s work to improve the health and well-being of our customers and communities.
Cost Savings and Improvements through Value-Based Care
In 2020, we generated close to $200M in cost savings and improvements through Blue Premier℠,1 our value-based care program. With Blue Premier, health systems share in cost savings if they meet industry-standard goals to improve their patients’ health. Blue Premier encourages doctors to manage each patient’s health care conditions more actively, leading to fewer hospital visits and more time for doctors and patients to communicate. more...
We expanded Blue Premier through contracts with North Carolina’s top 10 health systems and 353 independent practices.2 As of the end of 2021, more than one million Blue Cross NC members were covered by Blue Premier.3 Due to this transformation, 53% of members had their blood pressure regularly monitored and controlled in 2020.4
In January 2022, we began expanding our Blue High Performance Network℠ (BlueHPN℠) in the Triangle. Working with this network of doctors, specialists and hospitals that meet high quality standards can help members who are enrolled in BlueHPN through their employer plan receive the best care at lower costs.
New Advanced Kidney Care Program
On January 1, 2021, Blue Cross NC launched a value-based care program to give Blue Cross NC members with kidney disease access to better, more affordable health care. Members of Blue Premier Advanced Kidney Care receive care management, education and enhanced care coordination among their primary care provider and specialists. more...
We support providers in delivering high-quality, coordinated care for our members — for example, scheduling care to ensure that patients don’t miss needed appointments. This program is part of our Blue Premier value-based care program through a collaboration with Fresenius and Strive Health.
SmartShopper: Find the Most Cost-Effective Health Care
We want our members to know what their health care options are and choose the most cost-effective ones. SmartShopper® is one of our programs to help consumers save. The program lists how much a test or procedure costs at different local providers. When eligible members use a lower-cost provider through SmartShopper, Blue Cross NC rewards them with part of the savings – $15 to $1,000 per procedure.5 While this was initially made available for employer groups, in January we started a pilot program in Fayetteville to include members enrolled through the Affordable Care Act Marketplace.
Better Managed Lab Services
Lab work is a critical component of high-quality, cost-effective health care. Blue Cross NC works with Avalon Healthcare Solutions to manage our members’ lab services. Our collaboration with Avalon generated $112 million in cost savings and quality improvements6 for our members in 2020 by helping ensure that our members use facilities covered by their insurance and that health care providers follow clinically accepted guidelines.
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