Blue Cross Blue Shield, which for decades has provided nearly all health insurance coverage in North Dakota, is blanketing the state with forums to answer questions from customer/members.
The idea is to get everyone working together to cut health care costs while improving health and access to care, said BCBS head Paul von Ebers.
The first forum was tonight in Grand Forks. About 60 people attended in the Howard Johnson motel, not a few of them from BCBS and related firms. But several citizens, obviously concerned, showed up and asked tough questions of von Ebers, president and CEO of the Big Blues in the state, as well as to David Molmen, CEO of Altru Health System, based in Grand Forks.
"We don't want to say we don't have problems in health care," von Ebers said. "We do, and that's why you all are here tonight."
But it's these kinds of discussions that can help find better ways to deliver better care, von Ebers said.
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He showed he knows how to work a crowd, noting that a man asking about emphasizing healthy living more than medical care, was wearing an orange shirt advertising a road race.
"I like your 5K T-shirt," he said. "I'm a runner, too."
He talked about being "in the middle" of raising five children and kept a low-key approach emphasizing he didn't have all the answers.
A key in keeping health care costs down is emphasizing better ways of living and earlier care, instead of waiting until conditions require more sophisticated and costly medical treatment, Molmen and von Ebers agreed.
"These days, hardly anyone has to do physical labor for a living," von Ebers said. "So, we are living in a different world" than baby-boomers and older people grew up in.
Molmen illustrated the point starkly: In 1980, only 10 percent of adult North Dakotans were overweight or obese; today, 64 percent of the state's adults are either obese or overweight.
That leads to far higher health care costs, especially in diabetes and heart care, he said.
Why doesn't Blue Cross pay for behavorial therapy for autistic children, despite years of clinical research showing it works? a woman asked.
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His own son, who now is 26, has a childhood friend who is autistic, von Ebers said, so he's attuned to the issue.
"Health care costs a lot," he said. "So, we are obligated to figure out what works."
Blue Cross is part of a new study on that very issue, he said.
But it's difficult to know when enough research has been done, he said.
For example, about a decade ago, a certain controversial and somewhat exotic treatment for advanced breast cancer in women was tried across the country and insurance providers were pressured to cover it, he said. But, today, that treatment is widely considered ineffective and isn't used anymore, von Ebers said.
Why, asked someone else, does federal Medicare reimburse so much less in North Dakota for many medical procedures than it does in some other states?
Molmen gave a quick history of how Medicare initially set up cost formulas in the 1960s based on what each local region provided and for how much. It led to vast disparities, because the culture of North Dakota and Minnesota led to lower-cost procedures and less use of medical care by patients, than in other parts of the country.
That means that, as disparities grew, many procedures now done in, say, Florida and Louisiana, are reimbursed at twice the rate as they are in North Dakota, even though the end results are much poorer, Molmen said.
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Von Ebers said one improvement is the new office for a North Dakota Health Information Exchange, funded by federal and state money, to make sharing critical medical records between hospital systems better.
As recently as 2009, BCBS had 90 percent of the health care insurance market in North Dakota.
But in the past year or so, Sanford Health, after its merger with MeritCare, has won approval to begin selling health insurance in the state. Sanford already has about 25 percent of the market in South Dakota, where a Blue Cross agency also has the biggest share.
Meanwhile, some North Dakota hospitals, including Altru, have switched to using Medica primarily for insurance instead of BCBS, decreasing the Blues' dominance a little.
BCBS will hold similar forums across the state into October.
