BCBS To Administer State’s Reference Based Pricing Plan

If You Can’t Beat Them, Join Them…………………………BCBSNC embraces Reference Based Pricing in order to retain +700,000 employee lives in the great state of North Carolina……………..

Blue Cross Blue Shield To Administer Reference Based Pricing Plan for State


Starting on January 1, 2020, the North Carolina state plan will move away from a commercial-based payment model to a reference-based government pricing model based on a percentage of Medicare rates to reimburse health care providers for their services.

Blue Cross will administer the program.

Blue Cross said in a statement Thursday that “We share the treasurer’s concern of unsustainably high health care costs, and we will work with the plan and providers to implement this new strategy.”

Mark Hall, a professor of law and public health at Wake Forest University, said Folwell’s proposal “could have important, and perhaps even transformational, ripple effects if other large employers insist on using this same payment method in the private sector.”

The strategy takes the place of a request made by Folwell in May that Blue Cross cut by 15 percent the plan’s medical provider rate on “major competitive contacts” being negotiated this year.