Originally published in The Tennessean, June 2022
In 2021, BlueCross BlueShield of Tennessee paid out a record-high of $16.76 billion in claims costs to meet the health care needs of our members. Unfortunately, rising costs are predicted to continue: the Centers for Medicare & Medicaid Services reports that health care costs are expected to rise another 3.6% in 2022.
This is especially relevant now as the Wall Street Journal has reported that hospitals want to continue raising treatment costs, even as consumers face the daily effects of inflation.
Our founding purpose was providing financial security for members who faced health care costs they couldn’t afford. We’ve been in that business since 1945, providing peace of mind to millions of Tennessee families.
Now, Tennessee businesses and our members are asking us with greater urgency for cost savings.
How provider networks work for you
As a not-for-profit health plan, our top priority is improving the health of our members. We make sure the people we serve have access to health education, resources and safe, effective treatments. And focusing on preventive care and cost-effective treatments is a win-win that results in healthier, happier customers and lower costs for everyone.
We’ve always balanced choice — broad networks — and costs, knowing that both are important to health care consumers. But many customers are telling us they’d tip the scales in favor of lower costs.
Provider networks remain our most powerful tool to deliver savings. In exchange for discounted rates, these networks bring more patients to participating providers. These networks also help us make sure providers are meeting safety and quality standards.
We’re currently reviewing our provider networks and looking at more focused choices to deliver low-cost, high-quality care. Sometimes we may remove a provider from our network — or try to negotiate a new contract — if the provider is being paid or requesting higher-than-average rates or they aren’t meeting the highest quality benchmarks.
When this happens, we’re working on behalf of our members. These decisions are always difficult and are never made without first considering how our members will be affected and how we can continue to serve their needs.
More care options for our members
Even as we talk about developing more focused networks, we’ve also taken steps to expand access to convenient, high-value care. One example is the eight Sanitas Medical Centers in Middle and West Tennessee, which were opened specifically for BlueCross BlueShield of Tennessee members. We’ve also expanded our coverage of and support for telehealth.
For us, value is about outcomes and cost-effectiveness — not just the quantity of services a patient receives. It means finding new ways to partner with providers to support better health for our members.
We promote value through programs like the Medical Home Partnership (MHP), designed to improve our members’ overall wellbeing and address health care cost increases through effective collaboration with providers. MHP practices have BlueCross care coordinators helping identify member needs and provide the right level of outreach, driving quality care while lowering costs at the same time.
We’re a mission-driven company, and we’re responsible stewards of our members’ finances. We aim for long-term sustainability, not ever-increasing margins. And since managing costs for everyone is part of our goal, we’ll keep working to negotiate the best possible rates with hospitals and providers.
We’re carefully evaluating every opportunity on the table to make sure we’re meeting the expectations of our members and customers. As we face situations where our members’ best interest requires removing a provider from our networks, we never close doors completely and are always willing to renegotiate — to maintain affordability and quality care.