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A health care revolution is occurring in N.C., according to Blue Cross and Blue Shield executive

BOONE—Innovation and collaboration are the keys to driving a revolution in health care, according to J. Bradley Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina.

View larger imageJ. Bradley Wilson, president and CEO of Blue Cross and Blue Shield of North Carolina, said innovation and collaboration are the keys to driving change in the health care industry. Wilson spoke at Appalachian State University’s inaugural Blue Cross and Blue Shield of North Carolina Distinguished Lecture Series co-presented by the College of Health Sciences and the Walker College of Business. (Photo by Marie Freeman)

Wilson spoke at Appalachian State University Oct. 25 at the inaugural Blue Cross and Blue Shield of North Carolina Distinguished Lecture Series co-presented by the College of Health Sciences and the Walker College of Business’ Harlan E. Boyles Distinguished Lecture Series.

He said it was time for individuals, health care providers and the health insurance industry to have a common conversation related to health care.

“This is a revolutionary time in health care as we all come together and try to figure out new ways to improve quality in the delivery of care and lower cost in order to get more value out of every dollar that we spend in health care,” he said.

The current system that rewards and pays doctors and hospitals for the volume of procedures they provide and not for the value and quality of care delivered is unsustainable and driving the push for a new health care model that is more patient centered, collaborative and effective, he said.

“As a nation, we are spending more than $7 billion a day on health care and that number is going to go up,” he said. “At the current rate of increase, health care spending will be 20 percent of the nation’s gross domestic product by the end of this decade.”

That means that regardless of an individual’s age or salary, “one out of every $5 in your wallet is going to be spent on health care whether you are spending it or not,” he said. “That is an unsustainable economic model for the nation and it is an unacceptable and unsustainable economic model for us as individuals.”

In addition, Wilson said, “Our own bad habits are making things worse. Blue Cross pays about $12 billion a year in health care claims for its customers. $2.4 billion, or almost 25 percent of those claims, is related to conditions caused by smoking, being overweight and obesity.”

Wilson provided examples of collaborations between Blue Cross and Blue Shield of North Carolina (BCBSNC) and health care providers that are lowering costs without diminishing the quality of health care being provided.

The insurance company has partnered with the UNC Healthcare System to implement a model of health care delivery called Carolinas Advanced Health (CAH) that brings together medical professionals including doctors, physician assistants, nurses, nutritionists and case managers who put the patient at the center of a team. “It’s a one-stop shop and it’s getting dramatic results,” Wilson said of the program that is now in its second year.

In the first year, there were no avoidable hospital admissions out of CAH’s patient cohort and 64 percent fewer emergency room visits compared to BVBS customers, he said. “And most importantly, the patient satisfaction, reaction and scores are off the chart,” he said.

Another change is the creation of accountable care organizations (ACO) in which hospitals and physicians are rewarded for saving money through the efficient delivery of high-quality care. A partnership between BCBSNC, an independent physician’s practice and New Hanover Regional Medical Center developed an ACO model that Wilson believes will deliver higher quality care to patients at a lower cost.

“We have all come to realize – we being all the players in the health care system – that we can’t go off independently of each other and chart our own path and expect to be successful,” he said. “We have to work together if we are going to make the whole health care system better.”

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