As Senior Vice President and Chief Medical Officer of Blue Cross Blue Shield of North Carolina (BCBSNC), Rahul Rajkumar, M.D., J.D., leads the Healthcare Division. In this role, he leads healthcare program design and strategy, customer group consulting, medical expense management, care management, network provider contracting and relationships, health delivery redesign, plan and network quality initiatives, medical and reimbursement policy, and pharmacy. Dr. Rajkumar joined BCBSNC in 2018.
Prior to joining BCBSNC, Dr. Rajkumar was already an established leader in the move toward value-based care, having worked at both CareFirst and the Centers for Medicare & Medicaid Services (CMS). Dr. Rajkumar was Senior Vice President and Chief Medical Office at CareFirst Blue Cross BlueShield, a multistate Blue Cross plan that serves members in Maryland, Virginia, and the District of Columbia. At CareFirst, Dr. Rajkumar led efforts to reduce medical costs and improve patient care.
Before joining CareFirst, Dr. Rajkumar served four years as Deputy Director of the Center for Medicare and Medicaid Innovation (CMMI). He led a staff of over 400 and oversaw an annual budget of $1B, leading Medicare and Medicaid’s transition to new value-based payment models. He led the development of pioneering programs to promote Accountable Care Organizations, bolster primary care, implement bundled payments, and increase patient safety. This resulted in thousands of agreements with doctors and hospitals worth billions of dollars. Cumulatively, these programs shift 30% of all Medicare payments into value-based models and contribute to an unprecedented slowing of per capita Medicare cost growth from 2012-2016.
Additionally, Dr. Rajkumar has extensive clinical experience. Prior to joining CMMI, Dr. Rajkumar was an attending physician in the Department of Internal Medicine at Brigham and Women’s Hospital, and Instructor at Harvard Medical School, where he was responsible for patient care on an academic inpatient service and for supervision and teaching of residents, interns, and medical students. As a hospitalist physician at the Washington, D.C., VA Medical Center, Dr. Rajkumar provided care to our nation’s veterans.
Dr. Rajkumar earned his M.D. from the Yale University School of Medicine and his J.D. from Yale College of Law. He completed his residency at Harvard Medical School/Brigham and Women’s Hospital and is board-certified in Internal Medicine.