Thread by @RahulRajkumar11

We’re proud to launch our Accelerate to Value program today.

🚧Here’s how it works: THREAD🚧

First, independent primary care practices apply and attest to requirements – that they’ll maintain access for our @BlueCrossNC members, use telehealth, and help our members navigate through the unique health care challenges of the pandemic.

That means practices continue delivering high quality primary care like:

✅ Referring patients to public health resources like COVID-19 testing or for contact tracing
✅ Screening for behavioral health and #SUDs
✅ Delivering recommended preventative services
✅ Managing chronic diseases
✅ Supporting transitions of care
✅ Coordinating care

If they have not already done so, practices will need to join Blue Premier either with @AledadeACO or via an existing Blue Premier clinically integrated network.

Now, let’s talk about how the math works. Step 1: We’ll take the 2019 @BlueCrossNC revenue among the eligible universe of practices and compare it 2020. We estimate the shortfall year-to-date and a forecast through the end of 2020.

Step 2: Once practices apply and have been selected, we’ll begin distributing a payment for 2020 based on the shortfall multiplied by the number of @BlueCrossNC members who are attributed to your practice as defined by our visit-based plurality algorithm.

Step 3: In early 2021, we‘ll look back at the 2020 claims experience among the same group of practices and determine whether our forecast was too pessimistic or too optimistic.

If it was too pessimistic, @BlueCrossNC will update its payments and make another distribution to practices. If was too optimistic, providers will get to keep the money.

Step 4: In 2021, we will make a new estimate about the revenue shortfall for the upcoming quarter and repeat that throughout the year.

Doing the calculations in this way allows us to be responsive in how we support practices through the next two years. The #COVID19 pandemic is not under control. That’s why we knew we needed a way to make payments that could help practices smooth out this volatility.

While these steps are happening, practices will be signing up to join a Blue Premier ACO --- officially dismounting and waving goodbye to the fee-for-service treadmill (or hamster wheel)🐹👋 👋