Finding harmony in dissonance: Blues lead the way

Recently, I had the opportunity to sit down with Rachel Zeldin of Oliver Wyman at Oliver Wyman’s Health Innovation Summit 2024, where the theme was Working in Concert: Dissonance and Harmony.? Our conversation touched on several issues that are top of mind for leaders of the 33 Blue Cross Blue Shield Plans that comprise the Blue Cross Blue Shield Association (BCBSA).??

Dissonance distilled?

The concept of dissonance in health care is nothing new. I can remember when I led a Blue plan, and we were working with a local hospital and physician group to bring down costs and improve medical outcomes. A few months into the engagement, our dashboard showed decreased use of the neonatal intensive care unit. Fewer babies were in extreme crisis – wonderful, encouraging news. But speaking to one of the hospital’s executives, I could tell something was wrong. And then he said to me: “We just lost revenue. How are we going to make it up?”?

I tell this story to illustrate the crux of dissonance – and some tension – in health care. One entity’s revenues are another entity’s costs, driving many of our affordability challenges in health care today.???

A more immediate example is the introduction of GLP-1s. These “miracle” drugs have given hope to millions of Americans who suffer from obesity. But if we made GLP-1s available to all obese Americans, the cost would be more than $1 trillion annually! BCBSA conducted a study of 170,000 patients taking these weight-loss drugs, and we found that 58% discontinued use before reaching a clinically meaningful health benefit, and 30% discontinue use within the first month. Without adhering to a medication regimen, of course, patients will see no benefit from GLP-1s. Clearly, there’s a need for health policies to address the cost of the drugs, and equally important, we must put in place much better care oversight to benefit the people who need these medications most. The science behind the drugs is moving much faster than our ability to understand which patients will benefit, how to sustain their success, and how to pay for them. If we don’t get it right, we’re just driving up costs for everyone in the system with little to show for it.?

I offer these examples not because I feel dissonance is the driving force in health care today, but rather to point out that our approach to dissonance today feels different, in what is arguably the most dynamic health care landscape we have ever experienced.?

Driving Real Change??

As head of BCBSA, I’m inspired by the way our 33 member Plans – covering one in three American lives – are working in harmony to develop solutions to health care’s most pressing issues: affordability, accessibility, and equity.??

Health insurance premiums are driven by the cost of health care. Today, Americans spend an average of more than $25,000 a year on their employer-provided insurance. The cost of prescription drugs is a significant barrier to affordable health care for everyone, no matter if your ZIP code is 60611 or 02112. In fact, with 24 cents of every premium dollar spent on drugs, they are the most expensive component of premiums and are expected to continue driving up costs.??

The Blues aligned to drive transformation in drug pricing by launching Synergie Medication Collective in 2023. Synergie powerfully demonstrates the Blue System’s resolve to transparently address affordability for our members. As a collective, Synergie leverages the purchasing power of 100 million lives and is innovating in new ways – including the implementation of an outcomes-based contracting model at scale. We focused first on impacting the 30% of our drug spend ($46 billion annually) on medical drug benefits for expensive cell and gene therapies. Through Synergie, Blues were the first insurers to cover lifesaving multimillion-dollar gene therapies for sickle cell disease, impacting 100,000 Americans, with a guarantee of manufacturer refund if expected outcomes are not met. Today, Synergie is poised to impact the $110 billion the Blues spend annually on pharmacy drug benefits.??

A Unified Policy Platform?

The Blues are also working harmoniously to advocate for policies that advance affordable, accessible, equitable care for all Americans, especially around fair billing practices. Today, patients receiving the same care, in the same building, from the same doctor will pay much more for that care, just because the practice has been purchased by a hospital system that puts a new name on the building. In some cases, that simple name change can quadruple costs.?

We’re encouraged by the recent introduction of the FAIR Act and the SITE Act, both of which establish site neutral payments for outpatient care, and by the passage last December of two provisions of the groundbreaking Lower Cost More Transparency Act, including site-neutral and fair billing practices provisions.?

At the end of this year, the House and Senate have an important opportunity to?vote these two provisions into law. If Congress takes this bold step, the resulting savings – an estimated $6 billion over 10 years – could be wisely reinvested in our health care system, supporting initiatives to make care more affordable for American families and employers.?

Leveraging our Hyperlocal Superpower for Change at Scale?

As a trusted national partner with deep local roots, the Blue system is leveraging our hyperlocal superpower and national influence and coming together as an Association with one national voice, leaning in to drive real change at scale. I’m especially proud to share how we are implementing our strategy to address the youth mental health crisis.?

Since 2011, mental health-related visits to emergency rooms by young people have soared, and suicide-related visits to ERs have risen five-fold. Adolescents reporting major depression are up by more than 60 percent. More and more teenagers are being treated for anxiety, mood disorders and self-harm. Two out of three young people will experience some form of trauma by the age of 16.?

The cornerstone of our youth mental health strategy is a four-year partnership with the Boys & Girls Clubs of America. The Blue system is investing $10 Million in this initiative, which will train 48,000 staff members at more than 5,000 clubs across the county to be trauma-informed to better support the emotional and mental well-being of millions of children.??

Harmony overcomes Dissonance?

Addressing affordability, accessibility and equity requires a concerted effort from stakeholders across the health care ecosystem and a multipronged approach. Working in harmony to overcome dissonance, BCBS companies are committed to being part of the solution for all Americans.?