The pandemic brought about by a novel coronavirus is driving changes to control the cost of health care for Blue Cross Blue Shield of North Dakota, the state’s largest health insurance provider.

“I think (the pandemic) is going to change the way health care is delivered forever,” Dr. Greg Glasner, chief medical officer of Blue Cross Blue Shield of North Dakota. “We're not expecting it to go back to the baseline; we expect it to be more virtual going forward.”

Those changes, underway before the pandemic hit, have only been hastened by it and aims to reduce costs. As a result, the health insurer is working with providers to develop a hospital-at-home model that relies on expanded use of telehealth visits and a more robust adherence to medication protocols. Doing so lessens the need for expensive medical infrastructure that keeps costs high, BCBS officials say.

“The fee-for-service model of health care is bankrupting health care,” Glasner said. “It's bankrupting families, it's bankrupting everybody, so we need to figure out a way to change the value equation and how you get value for what you pay for, when you come in to be seen.”

Technology will be a driving factor in changing that model, according to Glasner, who said telehealth visits have exploded during the pandemic and are likely here to stay. Visiting a doctor virtually expands access for people in rural settings by reducing the need to drive long distances to be seen and, in turn, keeps the cost low.

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BCBS also is working to engage with pharmacists and providers to improve patients’ adherence to medication routines, which can prevent catastrophic illnesses later. A patient routinely taking medication to treat hypertension can keep that person from the hospital stay, recovery and costs associated with having a stroke, Glasner said.

The efforts to rein in health care costs come in a busy and challenging year for BCBS. Dan Conrad, president and CEO of BCBS of North Dakota, had been expecting to have break even this year, after taking losses the past few years.

When the pandemic hit, the volume of claims plummeted for nearly two months when people stopped visiting doctors amid concerns of contracting COVID-19. The volume of claims is what drives the expense side of the business. That reduced volume in claims was largely made up for in COVID-related claims, of which the company has paid out more than $47 million. Still, the company has not yet reached its pre-March level of total claims, which has had a positive impact on the company’s bottom line. Pent up demand for medical services, however, may push the number of claims higher towards the end of the year and into 2021.

“We're doing a little better than we thought we would be doing at this time had COVID not occurred, but we think that'll smooth out over time as folks start getting back to the doctor,” Conrad said.

Another concern for BCBS has been a drop in the number of its members -- about 10,000 people --due to unemployment. Those job losses are mostly concentrated in the western part of the state, where oil field workers were laid off due to what Conrad called the “double whammy” of COVID and the bottoming-out of oil prices. The company insures about 340,000 people in the state.

Despite the decrease in membership and the threat of a continued decrease, Conrad said the company has an adequate level of cash reserves for a plan of its size and is working to further its plans to reduce health care costs.

The company has taken a number of measures to assist people through the pandemic. It has waived $3 million in cost shares and co-payments, and, through its charitable foundation, has given more than $150,000 in grants to the Great Plains Food Bank, United Way and others. The company also has lent its assistance to the state by using its call center to communicate negative COVID test results to North Dakotans and has made thousands of calls per week.