Today We

are closer to ending the running tab on every test, procedure and pill.

This outdated model promotes unnecessary care and costs. See how we’re committed to picking up the pace of change.

Health care costs continue to spiral upward. In fact, in the U.S., we pay more for health care per person than any other country.1 Experts agree that the solution for transforming our health system lies in value-based care. But what do we mean by “value?” At Blue Cross NC, we believe it has four key components:

1. Cost: The high cost of health care is our customers’ number one concern. Slowing the rise is one of our top priorities.

2. Quality: From televisions to laptops, most technological products get better over time, often at reduced costs. It’s time for health care to do the same.

3. Health: Effective care should help patients be as healthy as possible without unnecessary extras, like duplicate tests; or avoidable complications, like preventable infections acquired while in the hospital.

4. Customer experience: Beyond making health care simpler, consumers need the resources to make informed decisions to find high-quality care.

At Blue Cross NC, we’re serious about addressing all four dimensions of value-based care. As the largest insurer in North Carolina, with deep partnerships with hospitals, doctors and community organizations, we’re focusing our efforts on:

  • Changing how we pay doctors and hospitals for care. We’re no longer simply paying for every test and procedure. Instead, we’re rewarding demonstrated health improvements and benefits to patients.
  • Looking at all aspects of health and wellness. The factors that affect patient health extend far beyond the walls of the doctor’s office. We’re investing in organizations that address the social determinants—or root causes—of health. These include programs that make homes safer for children, increase access to healthy food and arrange transportation to medical visits.
  • Investing in high-quality primary care because it leads to lower costs, higher patient satisfaction and fewer preventable hospitalizations—a win for everyone.2
  • Giving our customers more tools and resources so they can estimate costs, find the right doctor and make the best decisions for their care.

Our efforts have already begun to reshape the status quo. In a value-based arrangement with WakeMed Key Community Care, almost $20 million in savings, better care coordination and better patient experience for our members were realized.3 And our bundled payment arrangements—establishing a guaranteed, transparent price for the full course of care for knee and hip replacements—are generating savings and fewer patient complications. We’re planning to expand this approach to other procedures.