Value Based Reimbursement at Risk

Update 6/28/18: Success! Value Based Reimbursement is coming to North Carolina!

We have been talking a lot recently about Value Based Reimbursement (VBR). VBR is an innovative approach to health care reimbursement in which an insurer reimburses the care provider for the quality of the work, rather than the quantity (Fee For Service), as we typically do now. This allows doctors to provide the services they see as best for their patients without worrying about prior-authorization and other costly and time consuming processes. As a result, it could save North Carolina hundreds of millions of dollars.

However, despite the overwhelming support of the health care community, it is not currently legal in North Carolina for insurers and providers to enter into this kind of agreement for Preferred Provider Organization (PPO) plans, which is what most people have for their insurance. This is due to some outdated legislative language that the General Assembly attempted to correct in House Bill 382, the DOI Omnibus bill.

HB382 passed both chambers of the General Assembly with 0 “no” votes. In the House it passed 113-0 and in the Senate 45-0. But late last night, Governor Cooper vetoed the bill.

Now, to be clear, Governor Cooper did not express any opposition to Value Based Reimbursement in his veto.

The reason for his veto had to do with bond forfeiture. His exact reason, in his own words “Adding another excuse to set aside a bond forfeiture when a criminal defendant fails to appear in court hurts school funding and reduces incentives to ensure justice is served.”

It is unfortunate to see something that had support from many sides of the health care community, and held the potential for health care cost relief for millions of North Carolinians disappear as collateral damage from this unrelated veto.

We urge the House to override the Governor’s veto to ensure there is no delay in moving North Carolina to a more efficient health care system.

Update 6/28/18: Success! Value Based Reimbursement is coming to North Carolina!