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A major health plan in North Carolina has consistently been one of the leading payers in the United States driving the transition toward value-based care. Serving nearly 4 million members across the state’s 100 counties, the health plan knows that consumers are spending a steadily rising portion of their income on healthcare, demanding greater focus on increasing value and decreasing price.
When a large employer group reached out to the plan in 2012 for help motivating its employees to use high-quality providers, it took action and implemented a specialist designation program that differentiates specialty practices into tiers based on quality and cost. In 2018, the plan added network value/efficiency to the cost and quality specialty evaluation.