Combating Chronic Disease: A Problem that Plagues Minority Communities

Health care. It’s a phrase that conjures anxiety, confusion and frustration in our region and across our nation. And with just cause. As Americans, we spend twice as much on health care as residents of other developed countries, yet our health care system is plagued by poor quality, especially in the treatment of chronic diseases that affect millions of Americans. Within the next decade, we’ll begin spending more on health care – nearly one dollar in every five – than we do on the entire federal government today.

But health care is more than just an economic issue. It’s a social one as well. Our minority communities often suffer the most from skyrocketing medical costs. Consider this: chronic diseases account for $3 of every $4 spent on health care. That’s nearly $7,900 for every American with a chronic disease.  And minorities have high rates of chronic disease, including obesity, cancer and diabetes. One of the most glaring disparities is apparent in the African American community, where 48 percent of adults suffer from a chronic disease compared to 39 percent of the general population.

These numbers need attention now. We can’t wait for others to solve this problem. Chronic disease is a major driver of health care costs, and Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to working with physicians, hospitals and community organizations to address the problem. We know we have to reach the communities that are most affected. Here’s a snapshot of how we think we can tackle chronic diseases and their impact on the overall cost of health care.

Chronic Disease

As early as 2003, the independent Blue Cross and Blue Shield of North Carolina Foundation invested more than $22 million in free clinics across the state. This investment focused on implementing chronic disease management programs, providing affordable prescription drugs, targeting services to seniors and immigrants, and expanding indigent care services across the state.

A patient with a chronic disease may have to see multiple doctors in different locations, which makes it difficult for the doctors to keep accurate and up-to-date medical records on file. BCBSNC recently partnered with Allscripts to provide electronic health records to hundreds of physicians and free clinics across North Carolina to help solve this problem. The program wires doctors to improve the quality of care patients receive, while also reducing waste and redundancy.

Even with better information and more accurate records, it’s still costly and inconvenient for patients to see the multiple specialists that help them battle chronic conditions. So we’re partnering with UNC Health Care so these patients can get the coordinated care they need under one roof. Carolina Advanced Health, a new kind of primary care practice, serves BCBSNC customers with chronic conditions such as coronary artery disease, high cholesterol, hypertension, diabetes, obstructive lung disease and asthma. These patients receive a range of services, including primary care, medication management and preventive care, all in the same facility. Having a patients’ full team of caregivers working together in one location ensures patients get the best possible care in a setting that is convenient and efficient.

Obesity

Did you know that seven out of 10 African Americans ages 18 to 64 are obese or overweight? Or that African Americans are 15 percent more likely to suffer from obesity than Caucasians?  Did you know that two-thirds of the adults in North Carolina are obese or overweight, with numbers increasing above the national average?   This problem isn’t going away on its own.  At BCBSNC we are taking immediate action to address this growing epidemic.

In 2004, we launched Healthy Lifestyle Choices, a comprehensive program designed to combat obesity and get people on the path to a healthier lifestyle. One year later, we became the first insurer in the nation to pay doctors to treat patients for obesity as a primary condition. And we also launched other benefits to promote healthy weight.

To reach the children in our state, the BCBSNC Foundation launched Shape NC in 2010. Shape NC is a program designed to tackle childhood obesity by helping preschool age children form healthy habits early in life. The program educates kids in childcare facilities, their families, and childcare professionals about how healthy nutrition and physical activity, including how to create safe environments for outdoor play, can prevent obesity later on in life.

Earlier this year, we also partnered with the North Carolina Recreation and Park Association to help make healthy, locally grown food easier to eat by creating or improving community gardens in all 100 North Carolina counties within the next three years. The program is called Nourishing North Carolina and its goal is to provide almost 200,000 pounds of fresh fruit and vegetables to North Carolina communities. About 10 percent of that amount will go directly to shelter and rescue organizations.

Access to care

In the United States, racial and ethnic minorities and low-income populations experience serious disparities in rates of insurance and access to health care. Low-income Americans are three times less likely to have a regular source of care compared to those with higher incomes – and almost half of low-income Hispanics lack a regular source of care.

We have invested in a program with the North Carolina Academy of Family Physicians to increase the number of medical students exposed to innovative practices in family medicine and to encourage more of the state’s medical students to pursue a career in family medicine. Ultimately, this will help ensure that more North Carolinians have access to high quality primary care in the future.

The BCBSNC Foundation also supports a dental X-ray bus that travels around the state to provide free dental care to more than 6,000 people in North Carolina each year. The dental X-ray bus supports the North Carolina Missions of Mercy free dental clinics throughout the state by providing X-rays – a critical part of routine dental care – for uninsured or low income patients. Dental care is a critical part of a person’s overall health because dental screenings can detect diseases including diabetes, cardiovascular disease and osteoporosis.

Over the past 18 months we’ve seen great results from the dental X-ray bus:

• The number of NC Missions of Mercy patients receiving diagnostic X-rays increased from 22 percent to 72 percent.

• Twenty-eight percent more North Carolinians – 1,500 additional patients – received care as a result of the new technology.

• And, $3.1 million in donated dental care was delivered through NC Missions of Mercy clinics in 2010, up from $2.1 million the previous year.

We can’t talk about reining in rising medical costs without mentioning personal responsibility. At BCBSNC we’re doing our best to do our part, and we realize we have more to do, but for real change to happen we must all work together. Everyone who participates in the health care system – whether as a user or a provider of health care – as a responsibility to do what they can to help improve health and reduce costs. For many of us, that might mean losing weight, exercising more or giving up tobacco. It might also mean asking hard questions about the cost of care and available alternatives.

At BCBSNC we know we have to do our part, too. That’s why we are working provide the tools our customers need to empower them make informed decisions about their care. It is important that people understand what they are required to pay for a certain procedure or test, and why they are required to pay it. The goal of introducing transparent cost and quality measurements, like the treatment cost estimator available through our provider search tool at mybcbsnc.com, is to support our customers when they consult with their doctors so they can make more informed decisions about treatments and procedures. The treatment cost estimator provides information about the costs of various medical procedures, giving our customers an idea of what a procedure may cost, and provides them with information about how the costs may vary based on the physician or hospital they choose.

We agree with most people that we must find solutions to address chronic disease, and the medical costs that come with them. In April, we launched our Let’s Talk Cost campaign to demonstrate that all of us, including health insurers, play a role in rising costs – and more importantly, that we can all play a role in finding solutions. The campaign creates awareness with humor around the idea of “scapegoating” various participants in the health care market. But it quickly turns to straightforward dialogue around the issues and the challenges we’re all facing as health care continues to change.

We’ve seen great progress with more than 2,000 comments fueling the conversation on www.LetsTalkCost.com. And now, we’re beginning new conversations with business leaders, doctors and hospitals, consumers and others with the goal of identifying real solutions and putting them into practice.

Of course, the battle against costs has us looking inward as well. BCBSNC is working to reduce administrative costs wherever possible in order to take unnecessary pressure off customer premiums. •