Update: Maternity Health Episode-Based Payments Program

Feb. 17, 2022 Update: This communication has been updated to add the Federal Employee Program (FEP) as a participant in the program and remove Blue Card IPP Host.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is excited to offer a Maternity Episode-Based Payments Program (EBP). The Maternity EBP is a bundled payment program that promotes coordination and management of care, which results in the overall cost of care being reduced.

Retrospective Payment Approach

Members, providers, and the health plan all benefit from bundled payment arrangements with the potential to improve health and outcomes of members. The Maternity EBP is a retrospective bundled payment program, which means provider billing practices will not be affected. The retrospective payment approach allows downstream and non-risk bearing providers, as well as risk-bearing providers, to continue to submit claims in accordance with their provider agreements for services they provide to members in an episode.

Provider Incentives

Providers who participate in the Maternity EBP can benefit from a shared savings incentive.

At the end of a measurement period, if the episode cost is less than the average episode cost and the quality gap is met, then the provider will receive an incentive payment.

• During years 1 and year 2 there is no downside risk for the providers.
• At year 3 downside risk is introduced with a protection cap for providers.

Providers who are interested in joining the program can reach out to Blue Cross NC’s contracting team to begin the contract addendum process for Maternity EBP.

This communication applies to the following lines of business: Administrative Services Only (ASO), fully insured membership, State Health Plan (SHP), and Federal Employee Program (FEP).

*Segment participation may vary

For questions or more information, please contact BundleProgramInterest@bcbsnc.com.