“There are three distinct categories in the individual health insurance market, and each is affected differently,” said Patrick Getzen, BCBSNC vice president and chief actuary. “Rates are based on the population of each group and the medical services they use. There needs to be a mix of customers within each category to balance risk and expected costs.”

“Health care continues to evolve, and our collaboration with Carolinas HealthCare System is an example of how we can all work together across the health care industry to focus on providing quality and value,” said Susan Weaver M.D., chief medical officer of BCBSNC. “Our goal at BCBSNC is to continue to create innovative relationships with providers that shift the focus of care to high quality outcomes at a more affordable cost while enhancing the experience for our customers.”

“Exceeding the requirements assures Blue Cross customers of the value they receive from their insurance plan knowing that a vast majority of their premium dollar is spent on health care services,” said BCBSNC President and CEO, Brad Wilson.

CHAPEL HILL, N.C. – WakeMed Key Community Care (WKCC), an Accountable Care Organization (ACO), and Blue Cross and Blue Shield of North Carolina (BCBSNC) have signed an agreement that will enhance quality and provide greater value to BCBSNC members who ...

“This is the beginning of a journey,” said J. Bradley Wilson, the chief executive of Blue Cross and Blue Shield of North Carolina, which estimates that as much as 40 percent of its payments are now through one of the new arrangements. “The fee-for-service model is changing and is going to continue to change,” he said.

Subscription may be required. Still, some insurers say enrollees so far appear less healthy than they had projected. "It's even worse than what we thought," said Patrick Getzen, chief actuary for Blue Cross & Blue Shield of North Carolina. "We're seeing more chronic conditions than we would have expected," he said, and that will "put pressure on the 2015 rates." Among them are diabetes, depression, asthma, heart disease and cancer, he said.

“Employers are moving away from the one-size-fits-all model of health insurance. They recognize that someone 26 and single has different coverage needs than someone who is 48, married and has kids,” said Steve Crist, BCBSNC vice president of group market sales. “With the help of their employer’s financial contribution, employees can use the BlueBenefits Center to choose a plan that fits their needs and their budget.”

“Regular physical activity is essential to leading a healthy life, which in turn helps to control the cost of health care. But families shouldn’t have to choose between family time and a workout. In the right setting, you can accomplish these two things together,” said Brad Wilson, BCBSNC president and CEO. “Providing opportunities for families to become more active while spending time together at one of North Carolina’s most celebrated museums is a natural fit.”

Subscription may be required. "You can get some really good knees and hips for $20,000 at some facilities, but some are charging $40,000," says Elaine Daniels, a contract consultant at Blue Cross Blue Shield of North Carolina. The insurer offers bundled hip and knee replacements for its members at five hospitals, at prices that are about 20% lower than the local average.

“With the initial implementation phase of the Affordable Care Act behind us, we took a fresh look at the marketplace and the needs of our customers,” explained BCBSNC President and CEO Brad Wilson. “We’ll move forward with a sharper focus on those needs and a refreshed organizational structure to support that focus.”