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Blue Cross NC, Duke University Health System Team Up to Form Experience Health

Jointly owned company to feature Duke providers, offer Medicare Advantage coverage in the Triangle; represents latest collaborative effort for value in health care


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DURHAM, N.C. – Duke University Health System and Blue Cross and Blue Shield of North Carolina have together formed Experience Health, a new health insurance company created to meet the unique needs of seniors in today’s fast-paced world.

Experience Health has filed an application with federal regulators to offer a Medicare Advantage plan in 2020. Jointly owned by Blue Cross NC and Duke Health, Experience Health brings together two of the most trusted and innovative names in health care to create a locally owned and operated, non-profit health plan. Experience Health is committed to developing affordable and accessible products and services focused on improving health by:

•    Encouraging stronger patient-physician relationships through enhanced communication and team-based care
•    Using advanced data and analytics tools to provide optimal care to patients with health challenges such as diabetes and other chronic conditions
•    Improving care coordination so that patients have clear treatment goals and plans
•    And simplifying appointments, billing and timely access to health care professionals

“Consumers want the best possible health care that’s simpler and more focused on their unique needs,” said Patrick Conway, MD, President and CEO of Blue Cross NC. “Experience Health will offer exactly that by featuring exceptional Duke Health medical care with efficient Blue Cross NC operations. It’s another example of our desire to collaborate closely with the state’s leading health systems to improve quality, lower costs, and deliver exceptional experience.”

“Our goal at Duke Health is always to seek innovative ways to lead in the delivery of highest-quality care to our patients, their families and loved ones,” said A. Eugene Washington, MD, Chancellor for Health Affairs, Duke University, and President and CEO, Duke University Health System. “Experience Health represents a one-of-a-kind collaboration between Duke Health and Blue Cross NC to enhance the quality of care, the patient experience, and to bring even greater value to our patients.”

Blue Cross NC and Duke Health formed Experience Health to take advantage of the strengths of both organizations in a new type of collaboration. As a new entity incorporated in North Carolina, Experience Health has established agreements with Blue Cross NC to provide enrollment, billing and claims services to its customers, and with Duke Health providers and facilities to provide medical services, including population health management programs to improve the health of Experience Health members.

This is the latest of many ways Blue Cross NC and Duke Health are collaborating. For example, Duke Health is one of five leading health systems in North Carolina to join Blue Premier, the new value-based model of care in which Blue Cross NC and health systems are jointly responsible for health outcomes, cost and customer experience.

Experience Health intends to offer a Medicare Advantage plan in the following North Carolina counties, with coverage starting January 1, 2020, subject to approval by the federal Centers for Medicare and Medicaid Services (CMS): Alamance, Durham, Franklin, Granville, Lee, Orange, Person, Vance and Wake. If approved, Experience Health will be available as an option during the Medicare Annual Enrollment Period starting in the fall of 2019. Members may seek in-network care with Duke Health physicians and facilities.

Experience Health is governed by a board of directors consisting of three members each from Blue Cross NC and Duke Health. It has a professional staff headed by a CEO, Mark Waggoner, who has more than 20 years of health care leadership experience among health insurers and providers.

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