MMIT Payer Portrait: Blue Cross and Blue Shield of North Carolina

Founded in 1933 as Durham, North Carolina’s Hospital Care Association, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is now the largest insurer in the state, serving nearly 3 million lives. It offers commercial health products, including plans sold on the Affordable Care Act exchanges in North Carolina, as well as Medicare Advantage (MA) and Medicaid plans. Blue Cross NC is the ninth-largest Blues affiliate in the U.S.

The insurer is a partial owner of its pharmacy benefits manager, Prime Therapeutics LLC, the PBM owned and operated by 19 Blues affiliates. AllianceRx Walgreens Prime, the PBM’s specialty pharmacy partnership with Walgreen Co., handles much of the insurer’s specialty contracting, though like other insurers, Blue Cross NC contracts with several PBMs for specialty drug management.

In July 2021, Blue Cross NC entered the managed Medicaid market for the first time, following the introduction of North Carolina’s long-awaited Medicaid managed care transformation. With more than 430,000 members, the Blues affiliate is the current market leader, enrolling 25.9% of the state’s managed Medicaid population, according to AIS’s Directory of Health Plans.

In addition to bolstering its Medicaid segment, Blue Cross NC has also invested its efforts into value-based care in recent years. The insurer’s Blue Premier program, which launched in 2019, is currently collaborating with 11 North Carolina hospital and health systems and more than 870 private primary care practices. About 35% of the insurer’s members participate in Blue Premier, which fosters increased care coordination for members via shared financial risk agreements. The Blues affiliate said the program saved $197 million in 2020 and $153 million in 2019. The program reduced unplanned hospital readmissions by 15% in 2020, per an August 2021 news release.

SOURCE: AIS’s Directory of Health Plans as of March 2022; MMIT Analytics as of 2Q 2022.

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