Affordable care should be within everyone’s reach. We’re digging deeper to uncover the root causes driving costs higher to find solutions that make health care better for all.
Limited access to care in some areas of the state often delays treatment, leading to expensive emergency room visits and hospitalizations.
Chronic health conditions like heart disease, diabetes, and obesity are more prevalent in our state and require ongoing treatment and expensive medications.
Consolidation provides more leverage for health care systems to demand higher payments, which raises premiums for members.
Fragmented systems – like medical, dental, vision, behavioral, and pharmacy – make it difficult to navigate care and can lead to duplicate tests, missed follow-ups, or mismanaged health conditions. This drives up costs.
Price variation and lack of transparency make it hard for consumers to shop for affordable care.
The more than 50 health insurance mandates in North Carolina drive up health insurance costs for businesses and individuals.
Health care costs are rising fast, and the strain is showing across the system. The gap between what care costs and what families and employers can afford to pay is widening.
When costs go up, premiums often follow. That can shrink coverage options and leave people with fewer, more expensive choices. It’s a cycle that puts the entire health care system at risk.
At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we’re not just naming the problem. We’re partnering with providers, employers, and communities to test solutions, improve care delivery, and lower costs over time.
In a series of articles for the Triangle Business Journal, President and CEO Tunde Sotunde, MD, MBA, FAAP, has been exploring what’s driving these costs and what it will take to change the trajectory.
By being more efficient, more transparent, and more innovative, we’re advancing care for all North Carolinians and finding ways to make it more affordable.
No matter where a member lives or how much money they make, they should be able to access quality health care. We're improving access to care through our industry-leading Blue Premier℠ program, initiatives that save members money on prescription drugs, and innovative partnerships that expand and enhance care delivery.
By directly addressing the fragmented health care system and working with suppliers, we can focus on patients receiving higher quality, more affordable health care.
saved by members through our Blue Premier value-based care program since launching in 2019.
saved in medical expenses in 2023 by negotiating with drug manufacturers and implementing targeted cost savings efforts.
The program reimburses independent pharmacists for working closely with members to manage their conditions, making health care more affordable and accessible.
Carolina HealthWorks3 is providing a new, more affordable health plan option for North Carolina small businesses that gives employees and their families access to Blue Cross NC’s network of doctors.
The acquisition allows Blue Cross NC and FastMed to ensure access to quality, affordable care to any North Carolinian, regardless of their health insurance.
Our health care system should reflect the needs of the many different communities it serves. We have traveled to all 100 counties in North Carolina to meet with leaders and support solutions that empower individuals to achieve better health, address barriers to care, and ensure our purpose-driven approach creates lasting value for both our business and those we serve.
With initiatives with goals like tackling youth mental health issues or improving health through food and expanding access to care, Blue Cross NC is committed to creating healthier futures for all North Carolinians.
Health care doesn’t have to feel so complicated.
We’re putting resources and tools in our members' hands, like an in-network doctor search to find care nearby, a member knowledge center to help them navigate their insurance with confidence, and a member portal to manage their care and benefits all in one place.
As part of making health care easier to understand and more transparent, we routinely report how we allocate premium dollars so members know where their money goes.
For each dollar of premiums paid to Blue Cross NC, 87 cents goes toward paying medical expenses,4 including:
- 28 cents for professional services
- 26 cents for outpatient services
- 18 cents for pharmacy costs
- 15 cents for inpatient services
Of each dollar, 13 cents goes toward Blue Cross NC plan administration and taxes,4 including:
- 10 cents for customer service and operating expenses
- 2 cents for taxes
- 1 cent is net income
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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