5 ingredients for better, simpler, more affordable health care

The US is one of the most advanced nations in the world for acute care. If one suffers a heart attack or needs a hip replacement, America is where you want to get your health care – assuming you can afford it.

But if the goal is to establish a higher baseline for good health, it’s a different story. That’s where our ability to treat people when they are sick, how well we provide access to affordable care for all, and the overall health of the population all come into play. And that is where we are significantly behind, despite being one of the richest nations in the world.

I believe that in order to transform our health care system to be best in class, there are at least five ingredients critical to success:

Also known as population health. If there is one lesson COVID-19 has taught us, it’s that our health as individuals is dependent on the health of our communities. You cannot improve the health of individuals without addressing the environmental and social factors surrounding them.

Social drivers of health such as social isolation, adequate housing, food insecurity, transportation, access to primary care and other basic needs of life are critical to not only improving health, but also to addressing inequities that lead to health disparities. At Blue Cross NC – and through our independent Foundation – community health is one of our long-term strategic priorities. We continue to make significant investments to address these issues through our community and diversity engagement efforts.

• Over the past 20 years, our Foundation has issued around 1,000 grants totaling approximately $150 million
• Grants have included financial support for the training and education of primary care providers to expand access to primary care, especially in rural areas of the state
• $5 million in community supports during the COVID-19 pandemic with a focus on food security

We must address not only physical health, but also mental or emotional well-being and the non-medical factors that influence our health. The social and environmental drivers of health have a major impact on the quality of life for all of us. We must place the individual at the center of health care decisions: how, when and where people want to access care; how, when and where they want to interact with us as a health plan and so on. In other words, put people at the center of health care decisions.

At Blue Cross NC, exceptional experience is one of our long-term strategic priorities and we are making significant investments in consumer-centric tools such as digital assets, streamlining enrollment and secondary process, decision support tools (like our Find a Doctor feature, treatment cost estimator, our Smart Shopper tool). We’re also expanding our customer service capacity to enable our members to better manage their plan and to empower our customer service team to respond more immediately and efficiently.

Collaboration among providers and health plans is essential. Providers and insurers cannot live without each other. We all have the shared goal of ensuring access to care for all, improving the quality of care and making care more affordable. But far too often, it doesn’t look to consumers as if we’re pulling in the same direction. It’s time to change the traditional relationship between payer and provider.

Many relationships eventually reach the point where things just aren’t working any more, the “It’s not you, it’s me” moment. For payers and providers, it’s: “It’s not you, it’s not me – it’s the system.” The traditional system of paying for volume has become an obstacle to the affordable, quality health care that both payers and providers are seeking.

The symbiotic relationship between payers and providers has been made even more pivotal by the COVID-19 crisis. At Blue Cross NC, we have made significant investments in our Blue Premier value-based payment model to move from a fee-for-service, volume-based care approach to a model that pays for health outcomes. Our provider partners have enthusiastically embraced this new vision for outcomes-based payments.

We’re already seeing measurable progress on some of our cornerstone affordability initiatives:

• Eight of the state’s largest health systems are now part of our Blue Premier value-based initiative, helping achieve quality improvements and lower cost of care for our members
• Our Aledade primary care collaboration saw Year 1 savings of 5.6% reduction in medical costs, and average Medicare rating improvement from 3 stars to 4.5 stars

Data must be our guide. We have a ton of data in health care. The problem is that the data is fragmented and located in different systems that don’t speak to each other. As a result, we cannot unleash the power of the data we have.

When was the last time you’ve heard of anyone using a fax for anything but health care? It’s mind boggling that in the 21st century, none of us can access our personal health care data in a usable and meaningful way with the click of a button. We can’t make our health records available to whom we choose, including care providers.

We’re missing out on a tremendous opportunity to leverage all the data that could provide insights to emerging trends like COVID-19, predict where an outbreak is likely to strike, and discern what population characteristics are susceptible to the virus.

This again is why data, analytics and insights are strategic priorities at Blue Cross NC. We’re making investments in collating health care data, applying predictive modeling and employing machine learning to help provide insights on patterns of care, provider performance and patient trends. At the same time, we have to protect personal health information and respect individuals’ privacy. We must be deliberate and careful even as transformation gains momentum.

Common sense must drive access to care for all. For example, the Affordable Care Act has provided health care coverage for over half a million North Carolinians who otherwise would not have access to care today. We need policies that will improve the quality of care for all, like interoperability standards that will finally allow our varied records systems to speak to each other and make maximum use of data.

We need policies that drive affordability, like payment reform that will allow us to accelerate to value and drive down the cost of care. Let’s work on drug pricing and other policies that encourage – or at least do not stifle – health care innovation.

In order to transform our health care system to be best in class, there are at least five ingredients critical to success. They are key to better, simpler and more affordable health care. It is time for us to take these ingredients and work together to create a more equitable, affordable system that works for all of us. The Time is Now!