It seems like there’s not a lot that people can agree on in the current climate, but the high cost of health care is one of them. 

No matter where you live in the US, people understand that health care is too expensive and too complicated. Those feelings are even more intense here in North Carolina. Forbes magazine recently identified our state as the most expensive for health care in the United States. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to changing that.

Solutions are out there, but the health care system is complex – and no single person or institution can do it alone. Collaboration between providers and payors will be essential if those of us in health care are to achieve what’s mission-critical for all of us: ensuring that the people we serve have access to affordable, high-quality care. 

Unfortunately, the image of payers and providers always at odds with one another is engrained in public perception. The idea of institutions working together to problem-solve might seem like a pipe dream to a lot of folks, but some organizations in North Carolina are looking to change that narrative. Right now, Blue Cross NC is collaborating with different hospital systems, in different parts of the state – together, we’re finding new ways drive costs down, while making it easier for people to find the resources they need for good health and well-being.

Our work demonstrates that collaboration can – and should – take many different forms, making health care operate better and more efficiently by: 

• Helping patients navigate a complex system: Finding one’s way through the fragmented health care system can feel overwhelming and scary, especially for those with complex needs. Confusion and fear can lead to delayed care, inefficiencies, and poor health outcomes, which drive up costs for everyone. We’ve initiated collaboration efforts with more than a dozen key partner facilities – including Novant Health Forsyth Medical Center in Winston-Salem, Johnston Memorial Hospital in Smithfield, and Rex Hospital in Raleigh – to post onsite care navigators. These care navigators reach out directly to members at their bedside while they are still in the hospital. This face-to-face engagement supports discharge planning and ensures that members receive the guidance and coordination to make a smooth and safe move from hospital to home or the next level of care. We want to make sure our members have what they need continue their recovery and healing when they leave the hospital. Since September 2024, our onsite care navigators at various facilities across the state have helped more than 3,000 members. Not only has this resulted in estimated associated savings of approximately $16 million through raised awareness of benefits, increased adherence to recovery protocols, and improved discharge planning, it’s achieved these results by improving the member experience and, consequently, their health outcomes – which is precisely what we are all striving for.  
• Creating more access points to care: 61 of the 100 counties in our state have no psychiatrists who specialize in treating children and adolescents, as reported in the North Carolina Medical Journal. Many families in North Carolina don’t know where to turn for support when their child experiences mental health needs. Too often, they turn to emergency rooms at the last minute. Most emergency rooms aren’t equipped to provide durable mental health support, and these settings can make the anxiety and stress a young person is already experiencing even worse. AJMC estimates that reducing “avoidable” emergency room visits for mental health needs could save billions and improve patient outcomes. To help address this challenge in North Carolina, we’ve collaborated with UNC Health to launch a virtual intensive outpatient treatment program for pediatric mental health, with a focus on adolescent care. This program is one of the first of its kind in North Carolina and will be an important resource in our state’s shared work to address the youth mental health crisis: Families in care deserts or with inflexible schedules now have more options for help, and our provider partners have greater capacity and bandwidth to serve more patients.
• Easing the administrative burden: It takes a lot of paperwork to keep the health care system running. It’s essential work, but it’s time consuming for everyone involved. That doesn’t mean there can’t be more efficient ways of gathering and sharing the information we need to make sure our members are getting the best care. The cost of the standard manual process quickly adds up in different ways. The slow, back-and-forth collecting and sharing requires more labor hours spent doing the paperwork; allows less time meeting with patients; increases the risk of inefficiencies that slow down care; and leads to missed opportunities to identify and close care gaps. We’ve been working with large provider systems like UNC Health to automate that work; together, we’re building out a new clinical data exchange model that will allow providers and us at Blue Cross NC to share data quickly, seamlessly, and safely. By making it easier for everyone to do this essential work, our joint efforts will free up more time for providers to do what they do best – care for their patients –and better manage their revenue cycle (i.e., they get paid faster for the work they do). On our end, it will help Blue Cross NC get a more comprehensive overview of the care our members receive, and that allows us to spot where they might be having difficulties navigating complex care needs or finding resources to help them keep and stay healthy.
• Incentivizing quality over quantity: Our value-based care program, Blue Premier, has helped transform the industry. Blue Premier’s guiding principle is simple: incentivize quality, outcomes, and care coordination in the way we pay for health care, rather than paying simply for the volume of services delivered in the traditional fee-for-service model. This helps lower the occurrence of inefficient and costly events that can worsen health outcomes, like unplanned hospital admissions, preventable Emergency Department visits, and unneeded procedures. From the beginning, Blue Premier has depended on us standing alongside providers as a team, working together to agree on meaningful and realistic metrics for evaluating quality outcomes. The outcomes of those partnerships speak for themselves: Since its inception in 2019, Blue Premier has achieved close to $1 billion in savings. More than half of those savings were passed on to participating providers; the rest has been reinvested back into our members and programs designed to lower their costs and improve their health outcomes. 

These and other examples of our partnerships with hospitals and providers demonstrate what can be achieved when we work together – but, by themselves, they’re not enough to fix all the complex factors that are driving up health care costs. They’re a start, not an end point. 

The health care system too often fails the people it’s meant to serve – and that’s all of us. The problems are systemic, so the work to address those problems will have to be systemic too. Change will require unprecedented collaboration and cooperation between health insurers, doctors, hospitals, pharmaceutical companies, and the government. 

Blue Cross NC will be relentless to ensure access to care that is high-quality and affordable. Finding, pursuing, and executing on valuable opportunities to collaborate with others to make care more affordable is essential to that commitment.