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North Carolina Can’t Wait Any Longer for Value-Based Health Care

By Bryony Winn | November 5, 2018 | Industry Perspectives

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During my first few months as chief strategy and innovation officer at Blue Cross and Blue Shield of North Carolina (Blue Cross NC), I’ve been struck by the energy behind transforming health care in North Carolina.

And it was inspiring to see 160 business leaders show up recently at Triangle Business Journal’s Health Care Summit to discuss how we can accelerate the move toward better, more affordable care. Especially considering the meeting happened the same morning Hurricane Michael was hitting the Triangle!

I was invited to sit on a panel about value-based care, along with a set of wonderful North Carolina-based health care experts: Dr. John Meier from Wake Internal Medicine Consultants, Maraya Thorland from UNC Health Care, and Skip Woody from employer consulting firm Hill, Chesson & Woody. Our exceptional moderator Gary Salamido of the N.C. Chamber kept us on track.

No Going Back

As the discussion began, a couple of things became immediately clear: that real health care reform can only be accomplished if we leave behind the old fee-for-service model of health care and move to a system rooted in value.  

In a nutshell: a system where providers are reimbursed for the quality of health care provided to their patients, rather than the quantity of every test and procedure performed or medicine given. The panel was unanimous on the need to move away from our traditional fee-for-service model that rewards inefficient care and drives health care costs higher.

Putting into place such a system means fundamentally changing how health care is delivered and paid for in North Carolina and beyond. That won’t be easy or fast, but it’s necessary – and the process begins with conversations like the one at TBJ’s Health Care Summit with insurers, providers, hospitals, employers and business leaders talking it through.

To move beyond the 280-character limit on Twitter, I wanted to expand on some of the Tweets that quoted me:

I would argue that primary care providers need to be the backbone of our entire health care system. They are our coaches when it comes to preventive health and wellness. They are trusted advisors when we need help navigating the complicated health care system. They help us manage chronic conditions, which account for 84 percent of health care dollars nationally.

But a poll over the summer by the Kaiser Family Foundation showed that nearly half of 18- to 29-year-olds don’t have a primary care doctor. While 51 percent of all physician visits are to primary care doctors, these primary care visits account for only 8 percent of health care spending.

Finally, according to the National Center for Health Statistics, fewer than half of primary care doctors say they receive enough information from other providers to deliver truly coordinated care to their patients. Doctors simply don’t always have the right resources, tools and technological infrastructure to serve their patients. That means prevention and wellness services for consumers aren’t getting the resources they need.

Better Primary Care 

That’s why Blue Cross NC is placing a renewed emphasis on investing in and empowering primary care practices. In the coming months, you’ll hear more about specific investments we’re making to improve the health and well-being of North Carolinians by partnering for better primary care.

As fellow panelist John Meier noted, employers pay about $10,000 to cover health care for each employee every year. That means a business of 100 employees has to generate $1 million in profits just to cover health care for its workers. A million dollars! That’s a massive burden on any business, particularly a smaller one.

The business community must flex its muscle in the health care marketplace, demanding value-based contracts between insurers and health care providers. That will lead to lower spending and a healthier, more productive workforce.

It will also relieve employers of some of the headaches involved in shopping for their workers’ health care plans. Businesses should not have to become experts in managing health care costs and yet, in a fee-for-service system, they are required to make a dizzying string of decisions about the structure of their plans – instead of the health outcomes they’d like to see.

At a US Senate Health Care Committee hearing earlier this year, a Stanford University School of Medicine professor testified that about half of all health care spending in America is wasted. That amounts to about $1.8 trillion dollars that we didn’t need to spend. Even half of that would be a massive number!

Ask any working parent – or any business owner – how they feel knowing that they’re throwing away half of their health care. We need a system that rewards efficiency and innovation instead of continuing to pay for the volume of health care delivered.

Reducing spending on unnecessary and ineffective health care would raise our health care system up on the value scale by a significant amount. Beyond reducing this waste, we can make better use of data and analytic capabilities to identify health trends and craft more personalized care.

This effort is not merely an option – it is an imperative. The cost of health care is diverting scarce resources away from education and infrastructure in our national and state economies, and causing families to make unbearable choices between paying for health and other necessities. 

The audience for the TBJ Health Care Summit was a thoughtful group of leaders in business and health care, with many sharing innovative ideas and asking tough questions. Let’s harness our collective energy to get more for what we’re spending on health care.

The time is now. We can’t wait.