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Healthcare market evolution could benefit consumers

North Dakota’s healthcare market has been evolving, and the speed of the change has been picking up. 

Representatives of Blue Cross Blue Shield of North Dakota who spoke with The Minot Daily News recently indicated the continuing evolution could make healthcare not only better but help curb the rise in healthcare costs.

Both would be welcome events for consumers. No one wants to see large jumps in insurance premiums, as has happened at times in the past.

BCBSND President Dan Conrad described the historical insurance system as “churn medicine.” The more patients use medical services, the more reimbursements come to providers. In attempting to steer healthcare costs to a more sustainable level, BCBSND would like to move to a model that’s becoming more common in some other states, in which insurers partner with healthcare providers to keep patients healthy and out of the hospital. The reimbursement methodology would reward providers with increased payments and shared savings if patients don’t need to use as many health resources. BCBSND has been testing out the value-based reimbursement concept for about 10 years and says it is ready to move deeper into the model.

BCBSND also sees the continuation of an existing trend toward digital engagement. The COVID-19 pandemic has moved telehealth from a marginal part of healthcare to a key feature. BCBSND takes the position that telehealth is more cost effective so provider reimbursements should be adjusted accordingly. This whole business of payment parity appears headed to the state Legislature, but BCBSND suggests some cost savings could be turned back to consumers in the form of co-pay-free telehealth visits.

“We want to drive folks to those low-cost, highly effective ways to get care quickly,” Conrad said. “We want to reduce burdens to getting that type of care.”

In the end, the healthcare piece that remains the biggest challenge is prescription drugs. Once 10% of reimbursement dollars paid out by BCBSND, drugs now account for more than 30%. Only 1% of prescriptions are the highly expensive, specialty drugs, but more than 50% of drug costs are driven by that 1%.

Curbing healthcare costs isn’t easy. But if new approaches show promise in making a difference, they certainly would be worth a try. Consumers are ready for that kind of change.

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