We Resolve: To improve access to care in all 100 counties

Forty percent of North Carolinians live in one of our state’s 80 rural counties – that’s four million people who must travel long ribbons of blue highway just to visit one of our state’s bustling metropolises.¹

Small town life in North Carolina has much to offer: artisanal crafts, local eateries, a strong sense of community and breathtaking scenery. But when it comes to health care, many North Carolinians living in rural counties face significant challenges.

According to the North Carolina Institute of Medicine, rural populations are older, more prone to illness and less financially secure. They are more likely to experience drug and alcohol use, suicide, injury and teen births. At the same time, they also face more barriers accessing the health care they need to address these challenges.²

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to lowering these barriers. Our work is helping North Carolinians in all 100 counties to find easy, affordable pathways to better health.

Many rural communities struggle to maintain enough health care professionals to serve their populations.³ Blue Cross NC is providing support.

At the height of the COVID-19 pandemic, we invested heavily in a plan that has helped 513 local primary care practices­ – serving 500,000 members – weather financial challenges that few could have anticipated.

To strengthen the many independent practices that faced sudden decreases in revenue, we established our Accelerate to Value program and quickly began distributing “catch-up” payments to help eligible practices maintain 2019 revenue levels. By the fall, we had distributed $19.8 million through this program to participating providers. In return, the providers pledged to 1) ensure patient access to care, 2) adopt and enhance telehealth and 3) coordinate care activities in response to COVID-19.

Independent practices are vital to our health care system. They serve as critical partners in our efforts to address drivers of health. Accelerate to Value stands as one of the most comprehensive efforts in the nation to support them.

In addition, through our collaboration with Caravan Health, we are creating an accountable care organization (ACO) that will bring value-based care to rural and community hospitals across the state. By holding participating providers and Blue Cross NC jointly accountable for meeting quality and cost measures, this program will generate lower costs, higher quality treatment, and better coordinated care.

Our investments in rural North Carolina haven’t just helped strengthen practices and hospitals throughout the state – they’ve actually helped drive down costs. In short, they’re playing an important role helping North Carolinians in remote areas access healthcare that is more available, more affordable and better quality.

Rural Americans are more likely than those living in urban areas to die prematurely from heart disease, cancer, chronic respiratory disease and stroke.⁴ Many of these deaths are preventable. That’s why Blue Cross NC has invested in aggressive measures to help North Carolinians prevent and treat the chronic conditions that cause them.

Diabetes is one of the major contributors to heart disease, stroke and death – not to mention amputation, end-stage kidney disease and blindness.⁵ More than a million North Carolinians have diabetes. With more than 11% of the state’s population directly impacted, diabetes costs North Carolina billions each year. That includes $7.7 billion in direct medical expenses and $2.9 billion in indirect costs resulting from lost productivity.⁶ Data show that rural areas, especially in the South, have significantly higher rates of diabetes mortality compared to metropolitan areas.⁷

Blue Cross NC has partnered with Virta to provide a program that does much more than help patients manage their diabetes. Virta actually helps patients reverse the disease’s course. It’s also available at no additional cost to eligible Blue Cross NC members who have type 2 diabetes.

Virta uses a smartphone app to deliver nutritional guidance, online medical supervision and one-on-one health coaching.

Within one year of starting the program, 94% of Virta users either reduce their need for insulin or can stop using it entirely.⁸

Similarly, our collaboration with Carrot provides members with access to Pivot, a game-changing smoking cessation program, at no additional cost. Smoking is more prevalent in remote areas than in cities, putting rural residents at greater risk of lung disease,⁹ cardiovascular disease¹⁰ and even COVID-19.¹¹ By giving smokers immediate access to trained tobacco experts, nicotine therapy products, a personal breath sensor and an online community of support, the Pivot program helps users quit an addictive habit that is the leading cause of preventable death in the United States.¹²

How effective is Pivot? Initial studies found that 42% of program users successfully quit smoking in the initial survey period. After seven months, 86% of those who had quit remained smoke free.¹³ Almost 80% of Pivot users decreased their daily number of cigarettes.¹⁴

Given that the Virta and Carrot programs run through applications, they’re accessible from virtually anywhere. This means that members in more remote parts of the state won’t have to travel those long ribbons of highway to find support.

More broadly, Blue Cross NC is pursuing a statewide initiative to integrate mental health into primary care. Through a collaboration with Quartet, we have implemented an innovative strategy to help primary care doctors identify patients with underlying mental health conditions and substance use disorder. Through the combination of our own practice support and Quartet’s technology platform, physicians will find it easier to diagnose patients and connect them with the right care at the right time.

Whereas traditionally it can take months for patients to schedule an appointment with a psychiatrist or therapist, this program connects patients with behavioral health care within 72 hours. One in five adults will experience mental illness each year.¹⁵ Now, with the help of Blue Cross NC and Quartet, more people in all 100 counties will have timely access to the quality services they need to improve their mental health.

In addition to tackling some of the most pressing health issues that affect rural counties, the Virta, Pivot and Quartet programs reflect how Blue Cross NC is making strategic use of telehealth and digital technologies to ensure that North Carolinians can find quality care when they need it, no matter where they live.

Of course, we also recognize that good health depends on so much more than routine checkups and quality hospital care.

Meeting basic needs beyond traditional medical care is the foundation for good health, but not everyone has access to the same resources to meet these needs. Things like income, transportation, housing, and access to healthy foods and health care are all equally – if not more – important to our overall health. Yet, some people face significant barriers to these resources.

These indirect (non-medical) drivers of health play an important role shaping the overall health of a community. Data show that the ZIP code where we live directly correlates with our life expectancy, which can vary widely for people living across a county line – or even across town – from one another.

These inequities in community health impact us all. A healthier North Carolina will reduce the strain on our health system and minimize reliance on emergency room visits. This ultimately lower health care costs for everyone.

That is why we are committed to helping individuals and communities address drivers of health. Currently, Blue Cross NC efforts specifically prioritize food security, because a healthy diet is the most commonly reported unmet social need.

• We’re providing live support to help eligible North Carolinians enroll in the Supplemental Nutrition Assistance Program (SNAP).
• We’ve collaborated with food banks, community centers and schools across the state to increase their capacity to address food security. From the mountains to the coast, we have invested more than $7.1 million in food banks, supporting meal delivery and promoting farm-to-table healthy eating. And our investments are growing.
• We’re delivering healthy grocery boxes twice a month to eligible members with type 2 diabetes. But we’re not just bringing food. This program also offers health coaching support to drive critical behavioral change.
• Our Healthy Blue Medicaid Program offers three months of fresh fruits and vegetables for qualifying members and a 13-week voucher for WW (formerly Weight Watchers). We’ve also provided funding for the American Heart Association’s Mobile Kitchen and the UNC American Indian Center’s “Healthy Native North Carolinian” program, designed to facilitate healthy eating and active living.

When it comes to improving community health, food security is our priority, but it’s hardly the entire scope of our work. We are piloting new programs to address social isolation. We are supporting efforts to help individuals with low-income secure transportation to vital health care services. We are investing in a host of programs designed to help rural areas address their unique needs.

North Carolinians shouldn’t have to choose between where they want to live and good health. In fact, for most, there isn’t a choice at all. Home is where we are born. Home is where our families and friends live. Home is where our jobs are. Home is where our roots are planted.

Blue Cross NC is working to fulfill the promise that home is also where our personal physicians live – that home is where we find the resources we need to achieve healthy and happy lifestyles. We work each day to transform the health care system for everyone who calls North Carolina home.