Blue Cross, Key Physicians forming accountable care organization
Blue Cross and Blue Shield of North Carolina has struck a deal with Key Physicians, a doctor network in Wake County, to form an accountable care organization.
Key Physicians is comprised of 225 independent physicians and the ACO will allow those physicians to share more information with each other and BCBSNC, by far the state’s largest health insurer, with the hopes of cutting down on unnecessary procedures, ultimately reducing costs.
The doctors in the Key Physicians network are affiliated with each other, but each practice maintains its own tax identification number. As such, each practice still negotiates its own reimbursement model with insurance providers. By contrast, physicians that associate under one network, such as the UNC Physicians Network for example, negotiate reimbursements as a group, wielding more negotiating power because of their size.
With the new ACO model, there will be a shift in reimbursements, but those details have not been hashed out yet, according to BCBSNC.
“Working with Key Physicians 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 BCBSNC, in a news release.
BCBSNC wrote $5 billion in direct premiums in 2011; between the parent insurer and sub entities, it generated $201 million in net income that year, according to data collected by the N.C. Department of Insurance.