NC Blues, Duke start MA plan that will heavily rely on analytics

A new Medicare Advantage plan—created by North Carolina’s Blues plan and a major integrated delivery system—will rely heavily on data analytics to focus efforts on treating chronic conditions.

Blue Cross and Blue Shield of North Carolina (BCBSNC) and Duke University Health System are forming the new MA plan, called Experience Health, which is currently under review by federal regulators.

Pending approval, Experience Health is expected to launch January 1. To be based in Durham, it will encourage stronger patient-physician relationships through enhanced communication and team-based care, company executives say. The new plan will have improved care coordination, simplify the way members make appointments and handle billing, and how they will access their healthcare providers.

“Consumers want the best possible healthcare that’s simpler and more focused on their unique needs,” says Patrick Conway, MD, president and CEO of BCBSNC. “Experience Health … is another example of our desire to collaborate closely with the state’s leading health systems to improve quality, lower costs and deliver exceptional experience.”



Eugene Washington, MD, president and CEO of Duke University Health System said Experience Health will build on the strengths of the both organizations and will offer a “one-of-a-kind collaboration” with the Triple Aim of value-based care in mind—enhancing care quality, patient experience and value.

Experience Health will use BCBSNC to provide enrollment, billing and claims services, while Duke Health will provide medical services. Both organizations will be “jointly responsible for health outcomes, cost and customer experience,” they said.

Experience Health will be offered as a Medicare Advantage plan in nine North Carolina counties. If approved by federal regulators, Experience Health will be available as an option during the Medicare annual enrollment period starting this fall.

The new MA plan will be governed by a board of directors consisting of three members each from Blue Cross NC and Duke Health. Veteran healthcare management executive Mark Waggoner has been tapped to serve as CEO for the company. Waggoner formerly served as senior vice president of care integration and management at Blue Cross Blue Shield of Rhode Island and as director of network contracting at Harvard Pilgrim.

Health system interest in entering the health insurance business has been high since the Affordable Care Act was enacted in 2010, and some 40 such ventures having been launched since that time, according to a Robert Wood Johnson Foundation-sponsored report. Leaning on the strength of a dominant local provider brand and an experienced health insurer, these partnerships are enticing business prospects, because of their limited need for capital to launch, according to Allan Baumgarten, co-author of the study, in a Health Affairs blog entitled, New Provider-Sponsored Health Plans: Joint Ventures Are Now the Preferred Strategy.

“Looking ahead, it is unclear whether the strengths of the joint venture partners will be enough to overcome the challenges of starting new health insurance companies in turbulent times,” Baumgarten says.