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Published February 06, 2011, 12:00 AM

ND prescription to sustain state’s health care system

Our current health care system is simply unsustainable.

By: Paul von Ebers, INFORUM

Our current health care system is simply unsustainable.

As debate on health care reform continues, health care costs continue to rise – at an average of 8 percent each year, seriously straining everybody’s budgets. And regardless of the outcome of challenges to reform or its implementation, everyone recognizes we must find ways to rein in rising costs.

This is why Blue Cross Blue Shield of North Dakota and the state’s major health care providers have teamed up to develop a plan to reduce medical inflation by 1.5 percent, resulting in more than $30 million in savings over the next three years, and more than $15 million a year after that.

We’re not waiting to see what happens in Washington. Early in 2010, we began collaborating to develop local strategies and programs to sustain our state’s health care system.

Starting from a good place: Despite the challenges we face as a rural state – or maybe because of them – North Dakota is well-positioned to restrain costs. Because we have limited resources and serve many small, geographically dispersed communities, state providers and policymakers have long been collaborating and innovating to achieve high-performance health care. The quality of North Dakota’s health care is already rated among the highest in the nation, and BCBSND health insurance premium costs are among the lowest.

Another thing we have going for us is the common-sense, can-do, cooperative spirit that prevails in this state. Put it all together, and we have the ingredients to not only address our own problems but to serve as a model for the nation as well.

How will we do this? At BCBSND, we are aggressively working to contain internal costs without impacting customer service and satisfaction – even though our administrative costs are already at 7.6 percent – half the benchmark 15 to 20 percent mandated by national health care reform.

While internal changes are important, they are not enough. As North Dakota’s largest insurer, we understand that the cost of premiums directly reflects the cost of care – and patients are demanding more and better services. BCBSND claims expenses more than doubled from 2000 to 2009, from $547.9 million to $1.2 billion, resulting in premiums also more than doubling during the decade, from $608 million to $1.3 billion. The two go hand in hand.

Managing chronic and complex conditions: Chronic diseases and rare, complicated conditions that result in claims of $250,000 or more account for much of the spiraling cost. Two collaborative programs already in place in North Dakota directly address this issue, including MediQHome, a patient-centered medical home program that utilizes technology and North Dakota’s integrated health delivery systems to provide patients with tightly managed, coordinated care – improving quality and outcomes while reducing costs.

Paying for outcomes, not services: A patient-centered medical home approach changes not only how we provide services but also how we pay for those services. Payment is based on good outcomes rather than simply paying a fee for a service delivered.

Ultimately, this initiative is about doing what is right for patients. It’s about offering care that empowers them to better manage their conditions and resources that help them make wise choices. It’s about providing and paying for the right care at the right time. It’s about working together to do what works for North Dakota and sustaining accessible, high-quality health care for years to come.

Von Ebers is president and CEO of BCBSND.