The Pathway to Covering America: Ensuring Quality, Value and Access
Executive Summary
The Blue Cross and Blue Shield System strongly believes that everyone in America should have health insurance. However, we are concerned that a healthcare system that is unaffordable for many today will not work for even more people tomorrow. We must make addressing both rising healthcare costs and extending coverage to everyone a national priority.
We know Americans without the benefit of health insurance get sicker and die sooner than those with coverage. We also know that rising healthcare costs – driven by an epidemic of chronic illness that accounts for 75 cents of every health dollar – have made coverage unaffordable for many.
But the problems only begin with the cost. We do not know enough about what works in medicine – and even when we do, the advice is often not followed. For the $2.3 trillion we spend annually on healthcare, we should expect more than a system where patients have only a 50-50 chance of getting the most advisable care and where 30 cents of every dollar may be spent on care that is ineffective, inappropriate or redundant.
We can get to tomorrow's coverage, but only if we attack the cost and change incentives to improve the quality of healthcare. With this report, the Blue Cross and Blue Shield Association (BCBSA) lays out detailed recommendations to improve the quality and value of our healthcare system, while simultaneously expanding access and coverage to all Americans. Achieving better healthcare quality and value and expanded coverage begins with America undertaking five initiatives:
Improving Quality and Value
1. Encourage Research on What Works
America needs an independent institute to support research comparing the relative effectiveness of new and existing medical procedures, drugs, devices and biologics. We also must provide incentives to deliver safe, high-quality care.
2. Change Incentives to Promote Better Care
The incentives in our system must be changed to advance the best possible care, instead of paying for more services that may be ineffective, redundant or even harmful.
3. Empower Consumers and Providers
We must give consumers and providers the information and tools they need to make informed decisions. This starts with information systems to manage personal health records. In addition, consumers need to know how much they are paying and what they are getting for it.
4. Promote Health and Wellness
We must promote healthy lifestyles to prevent chronic illness and work aggressively to help patients with chronic illnesses manage their own health.
Expanding Coverage
5. Foster Public-Private Coverage Solutions
We need to tailor our coverage plans to capture the diversity of the uninsured population so that no one gets "squeezed out" by cost, "misses out" on available government assistance or "opts out" because they do not think they need coverage.
Clearly, there is no single answer for improving quality and value and expanding coverage. Meaningful change will depend on thoughtful, coordinated contributions from everyone – and it will require payers, patients, hospitals, physicians and policymakers to accept responsibility for taking part in the solution.
As leaders in the healthcare community for more than 75 years, the Blue Cross and Blue Shield System looks forward to working with all stakeholders to make quality healthcare affordable and accessible for all Americans.
Pathways to Covering America: Ensuring Quality, Value and Access (PDF, 2mb)
View webcast announcing the report
