When we talk about our customers at Blue Cross NC, we’re referring to a constellation of members, providers, employers and agents across the state. In 2020, the company upheld its commitment to making health care better, simpler and more affordable by adapting quickly to unprecedented change in our daily lives due to the COVID-19 pandemic. Across the enterprise, teams worked harder than ever to help our customers.
Reaching for the Stars
Based on efforts in 2019, Blue Cross NC received a 4-star rating for our Medicare Advantage (MA) HMO and PPO plans from the Centers for Medicare and Medicaid Services’ 2021 Medicare Star Quality Ratings. This high score truly validates our hard work at every step of the member journey such as choosing a plan, enrollment, accessing health care and claims payments.
2020 Qualtrics® XM Breakthrough Artist Award in Customer Experience
This international award recognizes the most innovative brands for “designing breakthrough products, services, cultures and optimizing experiences to the point that they delight and disrupt the status quo.” Blue Cross NC received the honor for its work in ramping up Voice of Consumer (VoC), an enterprise listening program, in 2019-2020. VoC delivers insights across multiple groups and segments to inform Blue Cross NC’s service improvements and member engagement initiatives with the resulting goal of improved business performance. The VoC team expanded stakeholder listening to include providers and administrators with insights from this effort guiding enhanced self-service capabilities into 2021.
AT A GLANCE:
Our Members
- 2020 Total Membership (including BlueCard®) – 3,861,722
- BlueCard – 1,174,433
- Major Group – 999,569*
- Local Group – 238,521
- Individual Under 65 – 467,406
- Federal (Medicare & Federal Employee Program) – 397,485
- State of North Carolina – 584,308
Our Financial Results
- Revenue – $9.9 billion
- Net Income – $260.5 million
- Net Income Ratio – 2.6%
- Taxes (Federal, State, Local) – $544.6 million
- Claims and Medical Expenses – $7.5 billion
- Months in Reserve – 5.38 months
*Excludes BlueCard Host; includes National Carolina’s Program and ACS Benefit Services.
Growing Blue Premier
Blue Premier generated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on health care in 2019, its first year.
Blue Cross NC’s Blue Premier value-based care program is one of the most rapid and comprehensive shifts to this model in the nation. It holds participating providers and Blue Cross NC jointly accountable for meeting quality and cost measures. Under value-based care, provider pay is based on quality of care, not on the quantity of procedures, tests and appointments performed. In other words, through a “shared risk” financial model, Blue Premier providers share in cost savings if they meet industry standard goals to improve the health of patients and share in the losses if they fall short.
The program’s first-year results were calculated in August 2020 from the five major health systems that joined at launch in January 2019.
Blue Premier also includes independent physician practices across the state participating through four accountable care organizations (ACOs) powered by a collaboration with Aledade. Collectively, the systems and practices met their performance goals for delivering high-quality, cost-effective care for the 536,000 Blue Cross NC members they served in the first year.
This collaboration helps doctors more actively manage a patient’s health care conditions, leading to fewer hospital visits and better health overall. Additionally, patients may have more time and more frequent communication with their doctors.
For example, they collectively increased screenings for colorectal cancer by an additional 3,041 members and controlled blood pressure for 13,412 more members than in 2018.
These efforts likely averted many heart attacks, strokes and deaths. Using estimates from the U.S. Preventive Services Task Force, the enhanced efforts in colorectal cancer screening alone could result in more than 800 additional years of life for Blue Cross NC members.
Blue Premier added three more health systems and more independent primary care practices since its inception. We can attribute 52% of our eligible membership to a provider with a value-based care agreement, surpassing our original goal of reaching 50% in 2020. We look forward to sharing our results from 2020 in the coming months.
In 2021, we estimate that more than one million members will be receiving care from primary care providers in value agreements.
Blue Cross NC made $85 million in performance payments to Blue Premier providers in 2019 as a result of delivering high-quality, cost-effective care.
Aledade is an independent company providing primary care services on behalf of Blue Cross NC.
AT A GLANCE: COVID-19 Response
Blue Cross NC acted quickly to help keep our members well, prepared and able to get the care they needed as cases of COVID-19 were discovered in North Carolina. Our teams launched a microsite, bluecrossnc.com/coronavirus, and translated many sections of the content into Spanish. This educational resource was the year’s top performing area of the public-facing website.
The company provided $600 million in COVID-19 relief for our customers and provider networks, including expanded telehealth options; early medication refills; expedited approvals for care related to COVID-19; and zero out-of-pocket costs for COVID-19 testing and treatment.
To help our members prioritize their wellness during such a difficult time, we issued $200 million in health and wellness retail cards to more than 600,000 eligible subscribers, or households, across the state (eligible subscribers are those enrolled in individual under 65 and fully insured employer plans, including vision and dental plans). The cards were loaded with $100 - $500, depending on their enrollment, and were eligible for health related expenses such as over-the-counter medications, food, first aid supplies, baby care items and more.
This direct benefit to our members was made possible by the funds we received from the federal government following litigation related to the Affordable Care Act (ACA) temporary risk corridor program. The United States Supreme Court ruled in April that the federal government is required to follow-through on the promise of the ACA risk corridor program covering 2014 - 2016.
In addition to the health and wellness retail cards, Blue Cross NC applied the remaining risk corridor funds to help keep 2021 rates for many of its customers lower. The company has been working hard to contain rates for several years and has achieved results. For example, for 2021, ACA plans offered to individuals will be reduced by an average of 1% on a statewide basis, for the third straight year and a three-year cumulative reduction of nearly $1 billion.
The “Made in NC” initiative was devised to serve the needs of the state’s health care workers by increasing equity in access to personal protective equipment (PPE).
Since the onset of the pandemic, demand for N95-approved respirator masks and other PPE has outpaced current U.S. manufacturing capabilities, resulting in supply chain challenges in delivering an efficient and reliable source at a reasonable cost. The shortage of critical supplies has left health care providers and essential workers at a higher risk of infection.
Made in NC can produce 100,000 - 200,000 N95-approved respirator masks per month through a unique statewide, cross-sector collaboration with Blue Cross NC, NC State University’s Nonwovens Institute, Freudenberg Performance Materials, UNC Health, the North Carolina Healthcare Association Strategic Partners and the North Carolina Medical Society. At full capacity, the collaboration’s manufacturing equipment is expected to produce up to two million N95 respirators per year.
tellBlue is Blue Cross NC’s online member insights community of 5,000 members from individual under 65 and local/major groups.
“I think a lot about how the pandemic will affect my future health and wellness. And so, in that sense, I appreciate that Blue Cross mailed a couple of masks to my house. I would have gladly accepted any other PPE that they thought was appropriate.”
Kyle, Blue Cross NC Member
“Ways that I think you guys can improve? It’s kind of hard because you guys pretty much are very prompt with sending emails about how to stay healthy, especially during the times of COVID-19, saying things like ‘wear your mask, make sure you wash your hands, make sure you social distance,’ things of that nature. You guys are very spot on with health related things that can be relayed to the masses and you guys do it very well.”
Hervon, Blue Cross NC Member
tellBlue Video Communications Survey, October 2020.
Since the start of the COVID-19 pandemic and through 2020…
7,000%
Telehealth increase
Over 35%
Of individual members used telehealth during COVID-19
Over 86%
Of individual members who haven’t used telehealth are open to it
Encouraging Whole Person Care
Behavioral health care (BH) in the U.S. is still largely reimbursed on a fee-for-service basis, and efforts to transition to value-based care lag behind physical health care. There are several reasons, including: Quality metrics are not clearly defined and can be subjective, a lack of consolidation among BH independent practices and a poor understanding of value-based care among BH providers.
However, we believe focusing on the whole person will help lower the cost of and improve patient outcomes in the primary care setting. So, we defined metrics and created our own value-based reimbursement program for BH providers called Blue Premier Behavioral Health.
By late-2020, 13,770 members were included in Blue Premier Behavioral Health. Final quality measures will be calculated, evaluated independently and reported in the 2021 Corporate Report.
Blue Cross NC teamed up with tech-enabled Quartet Health in 2020 to grow integrated care in the state and collect data on these quality metrics, which payers traditionally do not have an ability to measure. At the close of 2020, 2,635 primary care providers (PCPs) have been onboarded to Quartet, referring to a network of 2,110 independent BH providers.
Beyond behavioral health, and as an additional part of our focus on whole person care, we look forward to sharing results from partnerships launched in November with Carrot Inc. and Virta Health to address smoking and type 2 diabetes, two of the most pervasive (and preventable) health issues in the country. The cessation and reversal programs are available to individual under 65 members and fully insured group members.
- Smoking-caused health care costs in North Carolina: $3.81 billion per year.1
- Diabetes and prediabetes health care costs in North Carolina: An estimated $10.9 billion per year.2
“We resolve to make whole person care a priority, and that means we have to think beyond treating conditions, and work to prevent and reverse them.”
Von Nguyen, MD, MPH
Senior Vice President, Chief Medical Officer
Carrot is an independent company providing the Pivot smoking cessation program on behalf of Blue Cross NC. Virta is an independent company providing diabetes reversal services on behalf of Blue Cross NC. Quartet is an independent company providing data services on behalf of Blue Cross NC.
1. “Tobacco Use in North Carolina.” Truth Initiative, 28 June 2019, truthinitiative.org/research-resources/smoking-region/tobacco-use-north-carolina-2019. Accessed 5 Feb. 2021.
2. “The Burden of Diabetes in North Carolina.” American Diabetes Association, main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/north-carolina.pdf. Accessed 5 Feb. 2021.
Focusing on Drivers of Health
At Blue Cross NC we see many North Carolinians struggling with preventable, high-cost health conditions like hypertension, diabetes and maternal health issues. And that’s why we’re focusing on drivers of health.
Good health is dependent on a set of factors or conditions, and many are related to the environments in which people are born, live, work and play. These drivers of health (also known as social determinants of health) influence the health, functioning and quality-of-life outcomes/risks of every human being.
To support our members and communities more holistically, the Drivers of Health Strategy Team is looking at how Blue Cross NC can address the most urgent living needs as these evolve during and after the pandemic. More specifically, how we can support efforts that may or may not exist within our communities to provide regular access to food, reliable transportation and safe housing.
Blue Connect