Applying Upstream Problem-Solving to Value-Based Payment Reform in Specialty Care: Blue Cross Blue Shield of North Carolina’s Approach

AJMC April 6, 2021
David C. Johnson, MD, MPH, Rahul Rajkumar, MD, JD, Troy Smith, MBA

Effectively designing and implementing value-based payment reform for specialty care is challenging. The authors describe a commercial payer’s strategic approach to specialty value transformation.

You are walking along a riverbank and spot a baby floating helplessly down the river. You immediately jump in and pull the baby to safety. But what if, after you have rescued that first baby, you see another baby, then another, and then another, all floating down the river? By now you have exhausted yourself trying to pull each baby out of the water and realize that it is not possible to save them all. You may even be thinking, “Why are there so many babies floating down this river in the first place?” After going...

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