Op-Ed

More bang for your health care buck

A client enters the Blue Cross Blue Shield of North Carolina Triangle Sales Center in the Village Market Place shopping center in Morrisville, NC Saturday, January 9, 2016.
A client enters the Blue Cross Blue Shield of North Carolina Triangle Sales Center in the Village Market Place shopping center in Morrisville, NC Saturday, January 9, 2016. hlynch@newsobserver.com

Since moving to North Carolina a few months ago, my family and I have enjoyed getting to know our state and the people who make this such a great place to live. Given my role as president and CEO of Blue Cross and Blue Shield of North Carolina, I’ve made it a point to ask people what they think of their health care. Blue Cross NC insures the majority of people in the commercial market in NC, and many of them for most of their lives. This is a huge opportunity to improve health and lower costs for people over their lifetimes.

In my many different conversations, there was one constant: People don’t feel like they are getting what they pay for when it comes to health care.

It’s not hard to understand why people feel this way. Right now, spending is so high that if the health care system were to break off from the United States and become its own economy, it would be the fifth-largest in the world – bigger than the United Kingdom or France.

I am well aware that health care costs are out of control and, as a result, the premiums you pay for your health insurance are also too expensive. The question is: What can we do about this?

To make sure people can get the best possible care at the lowest possible cost, we need to focus on three specific things.

First, we need to make sure people are getting their money’s worth when it comes to their health care spending.

This means making sure providers are paid to keep people well, not for the number of tests or procedures they order. All new Blue Cross NC contracts with hospitals and health systems, and contract renewals since July 2015, have quality, cost-saving measures like this built in. This allows us to slow the rise of health care costs and improve a costly system that is long overdue for change.

In Wake County, Blue Cross NC has formed a collaborative partnership with WakeMed and Key IPA to improve quality and control costs. In just three years, we have reduced unnecessary costs by nearly $20 million. Models like this need to be the norm, not the exception. We would like to partner with hospitals and doctors across the state so the majority of payments and care delivered are in models where the hospital and/or doctor are working with us to improve your health outcomes and lower costs.

Second, we need to support people and communities in North Carolina to live healthier lives.

We need to address health-related social needs like housing, food insecurity and transportation. And we need to encourage exercise, wellness and healthy eating habits. As a not-for-profit health plan, Blue Cross is dedicated to improving the health of people and communities across North Carolina.

Blue Cross NC has invested millions of dollars in these kinds of community-centered initiatives since 2014. But we all have to do more. If we commit to making significant investments in our local communities, we will save money, lower costs and improve people’s health. Everyone wins.

Last, we need to make sure customers have the information they need to navigate the health care system and make smart, cost-efficient health care decisions.

We can all agree that our health care system often feels overwhelming.

For example, right now when you go to the doctor or hospital for a procedure, it is often hard to know how much it will end up costing you. Without this information, it is impossible for patients to make a fully informed decision. Consumers can’t win in a marketplace without price tags.

We understand the importance of transparency in pricing. It is why we launched an online cost estimator, allowing consumers to compare prices for more than 1,400 elective procedures. It’s also why we provide our customers with an online and mobile tool that allows them to see their personal out-of-pocket costs based on their specific individual plan.

These resources put consumers at the center of health care. They allow people to compare pricing and make smart choices about their own care. We are working hard to make the cost information we provide even better and easier to access.

Ultimately, this creates competition, which improves quality and controls costs.

I am a practicing physician who volunteers on weekends to take care of hospitalized children and their families. Interestingly, I am not aware of any practicing physician who has ever led a health plan of this size in the United States. Being a practicing physician gives me a deeper insight into the challenges that patients and families face in our health care system. I want Blue Cross NC to be a health plan that cares deeply about patients and families.

Blue Cross NC has been in North Carolina since 1933. We employ approximately 5,000 North Carolinians and insure people in every one of our state’s 100 counties. We will always be here for our customers and a partner that our communities can depend on. But we also have to continue to improve.

Improving quality and lowering costs is the right place to start. Right now, health care costs are unsustainable for our customers, and change is needed. Blue Cross NC is ready to lead that change. Blue Cross NC wants to be a Model Blue health plan for the nation that achieves better health outcomes, lower costs and best-in-class service experience for all of our customers.

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

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