Health Market Developments Could Benefit Consumers | News, Sports, Jobs

North Dakota’s healthcare market has evolved and the speed of change has accelerated.

Representatives of North Dakota’s Blue Cross Blue Shield who spoke to the Minot Daily News recently indicated that continued evolution could not only improve health care, but help curb rising health care costs.

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

BCBSND President Dan Conrad described the historic insurance system as “churned medicine.” The more patients use medical services, the greater the reimbursements for providers. In attempting to bring health care costs down to a more sustainable level, BCBSND would like to move to a model that is becoming increasingly common in some other states, in which insurers partner with health care providers to maintain healthy and out-of-hospital patients. The reimbursement methodology would reward providers with increased payments and shared savings if patients do not need to use as many healthcare resources. The BCBSND has been testing the concept of value-based reimbursement for about 10 years and says it is ready to take the model further.

BCBSND also sees the continuation of an existing trend towards digital engagement. The COVID-19 pandemic has shifted telehealth from a marginal part of healthcare to a key feature. BCBSND is of the view that telehealth is more cost effective, so provider reimbursements should be adjusted accordingly. This whole pay parity thing seems directed at the state legislature, but the BCBSND suggests that some cost savings could be passed on to consumers in the form of free telehealth visits.

“We want to lead people to these inexpensive and very effective ways to get care quickly,” Konrad said. “We want to reduce the burden of getting this kind of care.”

Ultimately, the health component that remains the biggest challenge is prescription drugs. Once 10% of BCBSND reimbursement dollars, drugs now account for more than 30%. Only 1% of prescriptions are very expensive specialty drugs, but more than 50% of drug costs depend on this 1%.

Reducing health spending is not easy. But if new approaches show promise in making a difference, they are certainly worth trying. Consumers are ready for this kind of change.

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