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How Are We Helping Customers Get More Value for Their Care?

It’s easy to blame health insurers for rising health care costs. We get it. After all, your insurance premium is the health care bill you most often see and pay for. But Blue Cross and Blue Shield of North Carolina (BCBSNC) doesn’t simply pass prices on to customers. We work behind the scenes to help make health care more affordable. Here’s how.

Negotiating with Doctors and Hospitals

BCBSNC negotiates with the providers in our network to get more value for the care our customers need. That goes for everything from routine doctor appointments to medication to major surgeries. For example, we negotiate with hospitals on the costs of things like facility fees, medical equipment and physician fees. This helps ensure that, in the event of an emergency room visit or hospital stay, our customers get more value for their health care dollar.

We also work to ensure that customers don’t pay for duplicate tests when one would suffice, or for unnecessary procedures that don’t aid in diagnosis or treatment. These decisions about standards of care are not simply based on price. They are developed together with doctors, nurses and pharmacists.

Rewarding Doctors for a Job Well Done

Everyone in health care has a responsibility to help improve care. We’re no exception.

At BCBSNC, we’re working towards a health care system that prioritizes value of care over volume of care. At the end of 2016, 82 percent of the total we paid hospitals went to those with quality-based contracts.

For example, we establish agreements with doctors and hospitals that reward value-based care. This means paying them based on increased patient satisfaction and improved patient health, rather than for the number of tests, appointments or services they provide.

One Procedure, One Price

Another way we join forces with doctors and hospitals to reduce costs and improve care is through bundled, or flat-fee, payment agreements. These agreements are designed to pay providers a pre-determined fee for complex procedures and provide patients with better results.

One such agreement between BCBSNC and Novant Health is for knee replacements. There, doctors collaborate to provide high-quality care and reduce complications and hospital readmissions. Bundled payment agreements include the costs of everything from pre-operative care through post-operative appointments and physical therapy visits. If care ends up costing more – for example, if a preventable infection arises – the medical facility absorbs any loss. If it costs less, the facility is rewarded. Thanks to this agreement, participating BCBSNC customers are expected to save 10 to 30 percent on the cost of a knee replacement.[1]

Taking Matters Into Your Own Hands: The Cost Transparency Tool

In the push for a health care system that focuses on the best care at the best price, you have a role to play too. You can make better decisions about how to invest your health care dollar with our cost transparency tool. It gives pricing and facility quality information for 1,200 non-emergency tests and procedures – everything from simple lab work to total joint replacements. Given that the price for the same procedure in the same town can sometimes vary dramatically, it’s definitely worth checking out.

[1] BCBSNC Internal Data, 2014.