BlueCross BlueShield of South Carolina

Health Care Solutions: An Invigorated Focus on Quality and Wellness

December 27, 2011

Sixty-five years ago this month, BlueCross BlueShield of South Carolina was created with a vision to give the average citizen access to health care. Today, more South Carolinians have health insurance — but many find that rising medical costs threaten their access to high-quality care. And as with the challenges of 1946, this one calls for creativity, collaboration and community effort.   

According to Harvard economist Michael Porter, U.S. health care costs currently exceed 17 percent of GDP. The magnitude of this figure not only hurts the country’s ability to compete in a global economy, but also can be devastating on a personal level. In fact, inability to pay for health care is often cited as the largest contributor to personal bankruptcy.  

There is vigorous debate about what should be done to change the trajectory of rising costs. But the good news is that concern about these unsustainable cost increases is uniting health care community leaders in the search for solutions.

BlueCross is engaged in numerous efforts to make health care more affordable. One collaboration in particular supports cost savings and increased access to high-quality health care — in a way that surely would have pleased the company’s founders:  by linking provider payments to coordinated high-quality health care delivery.  This approach shifts the health care system’s focus from illness to wellness. It rewards services and treatments that encourage healthy behaviors, which, in turn, helps to lower people’s risk for developing chronic conditions.  

In addition to early intervention in disease, the model also aims to integrate and provide improved continuity of health care services, especially for people with chronic conditions. It links provider reimbursement with positive outcomes for patients, rather than the current, piecemeal system that pays providers more for doing more. It is well-established that more care does not necessarily mean better care. And an estimated 30 percent of health care spending goes toward services that are ineffective or redundant — a staggering $750 billion annually. So it makes sense for BlueCross to focus on quality while trying to help drive down costs.

Why should South Carolinians care? Because hospitals and physicians across the state, in creative collaborations with BlueCross, are moving toward what is known as the Triple Aim: improving the experience of care, improving the health of populations and reducing per capita costs of health care.  A few examples of these efforts include employer-based pilot programs to raise awareness of the importance of colon cancer screenings, and incentive programs to help reduce hospital-acquired infections and “Never Events” (such as wrong-site surgery).

Another innovation involves using technology and an emphasis on best practices to deliver higher-quality preventive care. One illustrative example of this is the Patient-Centered Medical Home approach where a primary care physician leads a team of clinicians that coordinates all aspects of patient care. Data recently collected from a two-year study of 800 patients with diabetes from the Charleston-based Palmetto Primary Care Physicians group, showed that participants had better control of their blood pressure and cholesterol levels, fewer emergency room visits and fewer days in the hospital. Physicians were paid a bonus for patients’ improved health.

Working in concert with BlueCross, Patient-Centered Medical Homes are being replicated in medical practices across the state, with some groups expanding their efforts beyond diabetes care to include programs focusing on heart failure and hypertension. 

As we at BlueCross reflect on 65 years, we take pride in our history of providing access to health care for our neighbors and families. And we renew our commitment to the people of South Carolina. We look toward the future knowing what is required to continue our mission: a new level of partnership with providers who share our focus on quality and our commitment to keep health care as affordable as possible.