Achieving Affordability in Healthcare

Affordability is a concern for most patients and is often a major reason patients delay care. According to a 2019 Gallup poll:

• Forty-five percent of U.S. adults are concerned that a major health event could cause them to go bankrupt.
• One in four Americans admitted to skipping a recommended medical treatment in the past year because of the price.
• 15 million Americans put off purchasing prescription drugs in the past year because of the price.

Healthcare consumed just 4% of the average person’s income in 1960 compared to 6% in 2013 as healthcare costs have risen faster than the average annual income. This number is only continuing to grow, as the Centers for Medicare and Medicaid Services (CMS) forecasts national health spending will grow at an average rate of 5.5% per year through 2027, outpacing gross domestic product growth by nearly 20% over the same time period.

In addition, pricing for the same procedure varies greatly across the country.

As medical services are becoming increasingly more expensive, it’s up to insurers to eliminate or reduce burdensome costs on patients to ensure they are receiving the care they need.

How Blue KC is Eliminating Cost Barriers

Blue KC is constantly working to tackle rising healthcare costs and cost barriers for members with numerous tools and programs. 

As a commercial plan, Blue KC pays hefty premiums – almost 220% of what Medicare reimburses – to cover costs and make care more affordable to patients.

An effective tool includes Blue KC’s Cost Estimator, giving patients a transparent look at prices associated with many common elective medical services and procedures. This Cost Estimator can help members plan for medical expenses and compare costs of several services in an attempt to save them money.

Blue KC members also receive extensive prescription coverage, with each reviewed for safety, effectiveness, clinical outcomes and cost. CMS estimates that prescription drug expenditure will come to $360 billion dollars in 2019, compared to $265 billion six years ago. Blue KC aims to reduce the rising costs of prescription drugs for our members with continued comprehensive coverage.

In 2018, Blue KC announced Spira Care, a combined primary care and insurance offering that is easier to understand, access and afford. Members with the BlueSelect Plus plan experience no copays, deductibles or additional costs for care provided at the Spira Care Centers.

Lastly, Blue KC has placed a growing emphasis on telehealth to save members money on emergency room visits and transportation. We are proud to include American Well telehealth into most of our plans to help patients treat common medical concerns like colds and flu, abdominal pain, sinusitis, pink eye, ear infections and migraines, saving our members trips to urgent care. According to the American Telemedicine Association, cost savings is estimated at $19-$121 per telemedicine visit, compared to where the patient would typically receive care. Telehealth also helps patients save money by eliminating transportation costs and time patients could be spent working.

What Insurers Can Do

I challenge insurers to further explore new ways to drive down healthcare costs so that patients can receive the medical care they need to stay healthy. Whether it be through increased prescription coverage, price transparency tools or telehealth, we need to listen to our members’ cost concerns and find ways to make care affordable.