Partnerships with providers are cutting NC insurance costs

Dr. Steve Loehr checks on Angela Johnson in the recovery room at Triangle Vascular Associates in Cary in 2015. Blue Cross says deeper partnerships with providers will hold down health care costs.
Dr. Steve Loehr checks on Angela Johnson in the recovery room at Triangle Vascular Associates in Cary in 2015. Blue Cross says deeper partnerships with providers will hold down health care costs. ehyman@newsobserver.com

One thing I love about my job is that I get to see all parts of our health care system in action, bringing my perspective as a practicing physician with me. For the past year, I have had the honor of leading Blue Cross NC, meeting with thousands of employers, health care providers and customers across the state.

One conversation in particular has stood out to me. A woman in Raleigh insured by Blue Cross NC for all 75 years of her life was kind enough to share how much she appreciated the company for being with her through the high and low points of her life. It reminds me that our work has a lasting effect on the lives of all North Carolinians. We’re in a unique position to lead change in our health system and accelerate that change throughout our state.

But what does this change look like? The current way of paying for health care ensures that doctors and hospitals receive more money even when complications and errors occur. That’s not the way it will be going forward.

A new way of paying for care is taking root. And it’s working. Value-based payments change how we pay for care by creating deeper partnerships with health care providers. This means that doctors, hospitals and insurers work together, holding each other accountable for delivering high-quality care at a lower cost. With this philosophy, a preventable hospital readmission becomes an expense rather than a source of revenue for the facility providing the care.

Blue Cross NC achieved its historic rate decrease for Affordable Care Act plans in 2019 on the foundation of value-based care. In Medicare Advantage, our premiums are going down by 30 percent. This is an excellent start, and there’s no going back to the old ways of doing things. When applying value-based partnerships to large NC health systems responsible for 50 percent of health care costs, we can accelerate the shift in paying for quality that eventually drives lower costs for everyone.

On another side of the system, primary care influences 80 percent or more of all health care spending. Blue Cross NC is building a stronger foundation for primary care by investing in programs that recruit more students in the primary care field and in rural areas of North Carolina. Our investments will ramp up even further as we deliver more resources, more data and even higher payments that will help these physicians achieve better quality and lower costs for the patients they serve.\We must also invest in models of care that meet all of a patient’s needs, both physical and mental. Better integration of behavioral health care across the broader system will ensure customers are able to get the help they need to achieve addiction recovery and treat diseases such as depression. Together we can put an end to rising rates of addiction that are robbing our community members of their lives and livelihoods.

The causes of rising health care costs are multifaceted. Many circumstances outside of the doctor’s office influence a person’s health such as where they live, access to healthy food, housing, transportation and more. This year, Blue Cross NC made a landmark commitment of $50 million to create new partnerships and address these social determinants of health in our state’s communities.

Our state has one of the largest food and agriculture economies in the nation yet in some NC counties, eight out of 10 kids are hungry daily. Lack of affordable and nutritious foods is strongly linked to poor health, more chronic diseases and worse performance in school. By investing in programs that provide communities with better access to healthy foods, we are improving the overall health of our state.

No matter where you live, having the right information to make good health care decisions can make all the difference. For us, this means finding new ways to be simpler and easier to work with. We were the first health insurer in the nation to show the public the actual cost of many common procedures. We recently brought a new program to North Carolina called SmartShopper that makes it even easier to find cost savings and pays members cash for choosing high quality care at a lower cost.

All North Carolinians deserve better quality care at lower costs, and more change in the system is needed to make this happen. How can we ensure the next generation is healthier than the last and care is more affordable? I value every chance I get to hear from you as this work unfolds and together we figure out what’s possible and be a model for the nation.

Patrick Conway, MD, is president and chief executive officer of Blue Cross and Blue Shield of North Carolina.