Health care reform has been a roundly contested topic for employers, consumers and politicians even before Theodore Roosevelt campaigned on a promise of national health insurance 100 years ago. Group health programs have evolved for decades alongside constantly changing government regulations and growing involvement.
It’s hard to envision what health care and insurance will look like next year, let alone decades from now. That uncertainty, coupled with persistently rising costs, presents a daunting challenge for businesses and individuals alike.
Against that backdrop of history and conjecture, Blue Cross and Blue Shield of North Carolina (BCBSNC) endeavors to provide physicians, consumers and business owners with the tools and information necessary to make smart financial decisions and maintain better health care options.
Although headquartered in Durham-Chapel Hill, BCBSNC is emphasizing and enhancing its presence in western North Carolina; particularly, the greater Charlotte area. Presently, there are more than 50 employees in its Ballantyne office, led by Patrick Brady, Cooley Smith and Shannon Buckner.
Smith, manager of national and major accounts, emphasizes the fluidity surrounding the Patient Protection and Affordable Care Act signed into law by President Obama in March 2010. Though no one knows the shape that legislation will take by its scheduled full implementation in 2014, he says, it is critical to plan for change.
“Any employer who is not currently taking a good look at the situation is going to be in trouble once those regulations come into full effect,” says the 12-year veteran of BCBSNC.
To help businesses stay abreast of changes, Smith points to BCBSNC’s myriad tools and systems that facilitate an employer’s preparations for multiple scenarios. BCBSNC’s website contains up-to-date information on health care reform, designed to inform businesses and individuals. The company follows new regulations, analyzes pertinent data and provides expertise through sales and account management teams to clients, consultants and brokers.
“We’re encouraging an open dialogue with businesses large and small around the changes ahead,” says Buckner, in charge of middle markets retention, who has been with BCBSNC for nine years. “Those stakeholders include patients, physicians, insurers and employers,” he adds, “and their continued communication is a key component in health care evolution.”
Focusing on Charlotte
Participating actively in that conversation helps BCBSNC become more involved in civic life throughout North Carolina and increasingly in greater Charlotte, Buckner emphasizes. The Gaston County resident points out that he and the vast majority of BCBSNC’s 4,000 employees use the same schools, churches, businesses and health care facilities as their customers, so they have a personal stake in ensuring that the community is strong and that services are the best they can be.
“Our desire to be so deeply involved in the community is what makes us stand out from our national competitors,” Buckner says.
“To add value and remain relevant to our clients, we must innovate to improve health and well-being in each and every community,” says Brady, director of major and national accounts. Brady is a Mebane native who has called Charlotte home since 1999.
“This health-related work is going on nationally within BCBS plans,” Brady adds. “BSBC is dedicated to making a difference in the lives of North Carolinians through community betterment initiatives across the state and through the BCBSNC Foundation.”
Separate and independent, the BCBSNC Foundation has, since its inception in 2000, invested more than $70 million and supported more that 500 grants and special initiatives in communities across the state. These far-ranging programs involve the Foundation in efforts ranging from nutrition to health care for low-income families.
One important initiative of the Foundation is a full-fledged fight against childhood obesity. The Foundation is in the midst of a three-year, $3 million partnership with The North Carolina Partnership for Children, Inc. to focus on healthy weight for children from birth through 5 years old.
Called “Shape NC: Healthy Starts for Young Children,” the program focuses on changing the reality that 31 percent of North Carolina children ages 2 to 4 are considered at risk for becoming overweight or are already overweight.
A BCBSNC corporate program of note is Nourishing North Carolina. It is a statewide partnership with the North Carolina Recreation and Park Association, whose goal is to create a minimum of one urban garden in all 100 counties. BCBSNC President and CEO Brad Wilson kicked off the program in 2011 at a garden at Charlotte’s Winterfield Elementary School. Mecklenburg County will have multiple plots.
Partnering in Charlotte
BCBSNC is particularly intent on enhancing its Charlotte presence. Ellison Clary, a native Charlottean and a veteran public relations executive, was brought on board in late 2010 to help strengthen the company’s ties to the Queen City and help develop BCBSNC community initiatives.
With his assistance, BCBSNC has been able to increase its participation in the Charlotte Chamber, take a founding sponsorship in 7th Street Public Market, and help UNC Charlotte create its Chancellor’s Speaker Series and its celebration of National Public Health Week.
Other recent Charlotte efforts have included partnerships with 100 Black Men of Greater Charlotte, The Arts & Science Council, Care Ring, the Latin American Chamber of Commerce Charlotte, Charlotte Pride and Charlotte Center City Partners.
Clary says his 15 years with Bank of America taught him the value of teamwork across department boundaries, and he sees many of the same cooperative principles practiced at BCBSNC.
“There’s a healthy spirit of camaraderie; a feeling that we are all in our situation together and that we want to help each other succeed,” Clary says.
BCBSNC employees are also known for their individual commitments to community betterment. Since 1997, BCBSNC employees have logged more than 265,000 volunteer hours. Nearly 95 percent of corporate officers participate in outreach programs. Such unselfishness is vital for BCBSNC to address the complex issues affecting health care, Brady, Smith and Buckner agree.
BCBSNC is doing its part to encourage and support collaborative innovation to improve what CEO Wilson calls a tripod of concerns: cost, patient experience and patient outcomes. BCBSNC actively seeks to partner on community initiatives that help employers and employees understand their options and costs.
Collaborative Solutions Abound
Collaborative solutions to improve health care quality and reduce costs take center stage in BCBSNC’s newly refreshed Let’s Talk Cost campaign. The statewide effort includes advertising, social media and community outreach all focused on bringing ideas to the forefront and others to the table to improve North Carolina’s health care system.
“The ‘scapegoat’ phase of the Let’s Talk Cost campaign was important because it pushed the blame game to the side and got everyone talking about what we can all do to improve quality of care and rein in costs,” says CEO Wilson.
“These conversations matter,” continues Wilson. He cites one example: “We heard from our customers and the Let’s Talk Cost community that they want to know up front how much a procedure or office visit costs, and now that information is available.”
Another example is the Carolina Advanced Health initiative, a cutting-edge patient-centered medical home that focuses on care for chronic conditions. Developed by BCBSNC and UNC Health Care, the medical practice focuses on patients, not just their symptoms. All of a patient’s caregivers, from the chief physician to the physician assistant, physician therapist and even the pharmacist, are under the same roof. The arrangement saves time and money and ensures a smoother patient experience.
Another patient-centered medical effort was founded just across the Catawba River through a partnership between BCBSNC and Gastonia’s CaroMont Health. It created a new model for knee replacement surgery. Formerly, as with most procedures, a patient would visit multiple care providers and pay each separately. Under the new arrangement, a patient pays a single fee and receives care from a coordinated team of experts. The plan will be evaluated later this year and possibly expanded to cover other procedures and illnesses.
BCBSNC also has developed better tools for physicians to manage data and respond proactively to patient needs and requirements. A collaboration with Allscripts, a company that specializes in communication with hospitals and physician practices, will make electronic health records available to more than 750 N.C. physicians, including over 150 physicians in 39 free clinics. Electronic health documents allow physicians to set up systems to keep them proactively updated on patient needs. Further, it’s easier to notify patients when they are due for treatment.
Smith contrasts programs such as these with reform efforts of the past and points out a chief difference.
“BCBSNC is using a highly collaborative approach,” he says, “soliciting and listening to input and ideas from physicians, employers and patients. We are not dictating to anybody how this is going to play out. We want to sit down and listen to each other and find the common ground.”
Additional programs that have arisen from conversation and collaboration include employer-sponsored initiatives that reward employees for healthier lifestyle choices, such as losing weight or exercising regularly.
From a National Perspective
Brady, Smith and Buckner say BCBSNC lives by what in preaches. The company has tightened its own operations, pledging to cut more that $200 million in costs while working to retain as many of its 4,000 employees as possible. Consolidated branch offices and reduced overhead helps. And BCBSNC has not found it necessary to outsource any administration functions overseas.
BCBSNC has the strength and funding for great accomplishments, the Charlotte leaders add. Approximately one in three North Carolinians is covered by BCBSNC, the highest market share among health insurers operating in the state.
To explain that impressive position, Buckner again points to the company’s North Carolina roots and interests. BCBSNC is an independent entity, licensed by the national Blue Cross and Blue Shield Association. It operates separately from BCBS organizations in other states, and makes decisions based on the needs of individual communities.
Smith is quick to point out the larger perspective: BCBSNC is local, he agrees, but maintains national reach. The company provides the largest national provider network in the market, ensuring that individuals can find quality, covered care whether they’re in California, Ohio or Charlotte. Employers based in North Carolina can access BCBSNC coverage for their workers in any other state.
More innovation overall, chimes in Buckner, is another result of BCBSNC’s local focus.
“Changing the way physicians do business can’t be mandated from above,” Buckner says. “Doctors have to alter the way they practice because they believe in new methods and are confident they will benefit their patients as well as themselves.”
Predicting the future for health care and how to pay for it is well-nigh impossible in volatile times such as today, Brady, Smith and Buckner agree. No one can predict what turns health care reform will take nor draw up what a company such as BCBSNC will look like five years into the future.
But BCBSNC will continue accelerating the pace of providing options and giving patients more control and tools for better decisions, they promise. And BCBSNC intends to find more ways to encourage and teach people to live healthier lives and realize a better quality of life, they add.
BCBSNC is poised to respond to whatever health care directives may be dictated by health care reform and its inevitable changes.
“Whatever happens,” Brady says, “we will be here—collaborating with physicians, employers and patients to ensure the best possible outcomes for all.”