Addressing the health care cost crisis for a sustainable future

Across North Carolina, people face impossible choices – whether to skip care or cut back on essentials. This is an everyday reality for families, small-business owners, and seniors living on fixed incomes.

Health care costs are outpacing what people and employers can sustain. Real progress will take collaboration from insurers, providers, community organizations and policymakers moving in the same direction.

At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), we’re not just acknowledging the problem. We’re confronting it.

Through the Triangle Business Journal’s “Sounding the Alarm” series, our CEO Dr. Tunde Sotunde outlines the systemic drivers behind the crisis: fragmentation, misaligned incentives, and regulatory complexity. His op-eds and the accompanying articles go beyond diagnosis; they offer a blueprint for change.

Transparency is the start

Let’s begin with the basics. Where does your premium dollar go? At Blue Cross NC, 87 cents of every dollar goes directly to medical care and services. We’ve broken it down on our affordability page. The premium dollar bill graphic below shows exactly how your money is spent. Transparency isn’t a buzzword; it’s a commitment.

As a highly regulated insurer, we’ve consistently exceeded the expectations placed on us, ensuring that more of every premium dollar goes directly to patient care and vital health services. We continue to uphold our commitment to offer coverage in all 100 counties because every North Carolinian deserves access to care.

Collaboration is key

No single organization can fix this alone. That’s why we’re working across the health care ecosystem to drive affordability. Here’s how:

• Blue Premier:Our value-based care program with providers has saved nearly $1 billion since 2019 by rewarding quality over quantity. Providers share in the savings, which are reinvested into patient care. Members experience fewer hospital visits, better management of chronic conditions, and lower out-of-pocket costs as a result.
• Hospital Partnerships:We’re collaborating with Novant Health, UNC Health, and others to introduce care navigators and virtual pediatric mental health programs that improve outcomes and reduce costs.
• Primary Care Expansion: We’re protecting access and expand offerings by integrating primary care into FastMed clinics. This effort helps meet growing demand, especially in underserved areas, and supports whole-person care, all while keeping FastMed open to everyone in North Carolina, regardless of insurance.
• Pharmacy Innovation:More Than a Script empowers community pharmacists to manage chronic conditions like diabetes and hypertension, closing gaps in care and improving access to life-saving medications. We partner to offer ways members can save on prescriptions with MedsYourWay and FlexAccess. Members’ prescription savings on average are $120 annually.
• Health Through Food: We’ve launched a statewide initiative with community organizations, farmers and providers across the state to treat food as medicine, especially for diet-related chronic conditions. It will improve lives and lower costs for everyone. One example: our Feed Your Health program, at no additional cost for members with Type 2 diabetes, led to a 1.5-point drop in A1C in just 16 weeks, along with improvements in food security, mental health, and overall well-being.

We can’t afford to wait for perfect solutions. We must face this issue head-on, together. That means building new partnerships and strengthening existing ones.

This isn’t a moment for cautious optimism. It’s a moment for bold leadership, urgent collaboration, and shared responsibility.

Let’s rise to it together to race toward a healthier future for North Carolina. The challenge ahead is like a marathon, not a sprint, requiring everyone; insurers, providers, pharmacists, employers, and community leaders, to push forward in unison. By combining our strengths and moving with purpose, we can cross the finish line together, ensuring affordable, accessible care for all.