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Record-High Claims in 2021 Reflect COVID-19’s Impact on North Carolina

By Mitch Perry | March 1, 2022 | Industry Perspectives

A medical staff member works at the intensive care unit for patients suffering from COVID-19

A year ago, we expected the financial impact of the COVID-19 pandemic to increase during 2021 compared to the previous year. And that was before the arrival of the delta and omicron variants of the virus.

COVID-19 is indeed a global pandemic, but it’s also local. Last year, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) saw eight of the highest months of medical claims in the company’s history. Claims and medical expenses reached an all-time high of $8.2 billion in part due to our company’s strong growth in membership, including Medicaid. But per-member claims also continued to climb, largely driven by rising drug costs – particularly specialty drugs – and the surge of the omicron variant of COVID-19.

The COVID-19 pandemic has had a persistent impact on our customers over the past two years – most importantly in human terms. But beyond illness, anxiety and heartbreak, there is also a financial impact. Blue Cross NC saw COVID-19 spending increase from less than 4% of our total medical spending in 2020 to well over 5% in 2021, an increase of more than 25% over the previous year. We paid nearly $380 million in claims for COVID-19 treatment, testing and vaccinations for our fully insured business, up from $185 million in 2020.

Blue Cross NC handled around 4.7 million claims for vaccines, testing and treatment, with a total of 285,000 members seeking at least one COVID-19 treatment. And while COVID-19’s cost in human terms can’t be calculated, the pandemic carries a price tag – and it’s a hefty one. The average cost for an ICU admission for COVID-19 for our members was $59,000 – which is double the cost of a non-COVID ICU admission.

Patient and provider interest in taking advantage of telehealth consultations has skyrocketed during the pandemic, with telehealth claims rising by more than 7,500% in 2020, a trend that persisted into 2021. This equates to about $76 million in telehealth claims per year.

These figures confirm that making health care affordable must remain a priority not just for our company, but across all of health care. This is urgent work, as the COVID-19 pandemic and the variants that emerged in 2021 brought continued volatility to health care and to financial markets, and it reinforces the importance of our company remaining financially strong to address the short-term and longer-term needs of our customers.

Other Cost Drivers

Beyond costs related to the pandemic, rapidly increasing spending on prescription drugs and rising price tags on medical tests and procedures were some of the top contributors to the record-high claims we saw in 2021. We are partnering with providers and others across the health care industry to address these rising costs, but we expect these issues to continue to put pressure on affordability.

Drug costs continue to accelerate at a rapid rate. In 2021, spending on prescription medications was up 10% over the previous year, with specialty drugs including those for autoimmune conditions, antidiabetics and oncology medicines up 15%. Costs of prescription drugs have been responsible for nearly half of our overall cost increases over the last two years.

We are executing a strategy that aims to bring down these costs and increase access to life-saving medicines. But there is more work to do on lowering drug costs for our members.

The pandemic also contributed to an increase in behavioral health claims, which jumped by 20% last year. Behavioral health spending now makes up about 3% of the company’s overall spending. We are looking at this increased spending on behavioral health as an investment that may help to prevent costly chronic health problems in the future.

Financial Strength

Our membership grew by 11% to nearly 4.3 million – including customers we serve on behalf of other Blue plans – with 440,000 new Medicaid members joining Blue Cross NC through our Healthy Blue offering.

Making health insurance more affordable is essential to expanding access to care; in three of the past four years, we’ve lowered premiums for our individual under-65 members. Despite the disruptions caused by the pandemic, we continued on our course to welcome new providers to Blue Premier, our value-based reimbursement model that has generated $350 million of savings in its first two years.

When we’re financially strong, we can make investments in communities, supporting the network of nonprofit organizations on the front lines of health and education. This community support is an important way we are making investments in better access to health care, better health outcomes and affordability.

We continue working with North Carolina communities to address non-medical drivers of health, which include a wide range of social, economic and even geographic issues that impact our well-being: food security, transportation, social isolation, safe and adequate housing, substance use disorder and addiction.

Looking Ahead

While we are seeing encouraging trends in COVID-19 infections and hospitalizations, many in the medical community believe the virus will ultimately transition from urgent crisis to seasonal threat. This will cause continued uncertainty for the broader health care community.

Volatility is nothing new in health care, and Blue Cross NC is prepared for it. As we have for nearly nine decades, we will continue to be here for our members, meeting their needs today and responding to their changing health needs in the future.