Dynamic Activity

Throughout human history, revolutions have resulted in economic shifts, major changes in culture and the upheaval of established institutions. Brad Wilson, president and CEO of BlueCross BlueShield of North Carolina (BCBSNC), is counting on a healthcare revolution that will give rise to all of the above.

One of BCBSNC's innovations is Carolina Advanced Health, a brick-and-mortar clinic that is jointly owned and operated by the health plan and University of North Carolina (UNC) Health Care, a not-for-profit integrated system. The payer/provider equal partnership marks a dramatic change from days past when stakeholders were more likely to viciously face off at a negotiating table than to work together in a community.

In today's healthcare market, refined reimbursement mechanisms shift some risk and accountability to providers, while on the other side of the equation, plans are becoming more involved in driving best clinical practice. Alongside the blending payer/provider relationship, member engagement is also increasing. Wilson welcomes the shakeup because it will drive transformative innovations such as the Carolina Advanced Health clinic.

What's unique about the primary-care clinic is not just the payer/provider partnership, but also that it was designed from the ground up as a patient-centered medical home with technology and workflow processes to match. Members with chronic conditions are identified and directed to the clinic for enhanced services. The site is exclusively for BCBSNC members, and care is delivered by salaried clinicians hired specifically to drive the model.

"We all had to get comfortable with a new level of risk and reasonable risk taking, but it pushed the edge of our comfort zone," Wilson says.

He also says he's particularly gratified by the fact that BCBSNC and UNC Health Care collaboratively designed the clinic model and had the facility up and running in just 18 months.

"The transformation is happening at such a rapid pace that every participant in the healthcare system from patient/customer to health plan CEO to the academic medical centers must pick up the pace and respond with a new sense of urgency that we have never experienced before," he says. "And, frankly, sometimes it's a little daunting."

On Dec. 7, 2011, in Chapel Hill, N.C., Wilson and UNC leaders cut the ribbon on the 10,000 square-foot Carolina Advanced Health facility. It offers chronic-care patients the full range of services from its staff of experienced family physicians as well as the services of pharmacists, a behavioral health specialist, a care manager, and a nutritionist and health coach. The clinic and its on-site lab have the capacity to serve 5,000 BCBSNC members.

"The employees are medical professionals that we've recruited that bring to this practice an experience and a philosophical alignment with the concept of a patient-centered medical home," he says.

For example, at the end of the day, the team meets to discuss patient issues and review best practices for each case. Chronic conditions addressed include: diabetes, high cholesterol, high blood pressure, asthma, chronic obstructive pulmonary disease, heart disease and congestive heart failure. Medication management and health coaching keep the patients engaged in self-care between visits.

Such care coordination is encouraged among the clinicians but also outside the facility walls as well. For example, an online patient portal offers personal health records, previsit planners, online appointment scheduling and referral requests.

"We're also leveraging telemedicine so there can be conferences with physicians and patients," he says. "We're leveraging all the latest technology to see how it's going to work and make a difference to increase quality and lower cost."