BCBS Companies Are Leading Efforts to Combat the Opioid Epidemic

Our country is facing a serious and growing public health crisis. Every day, 91 Americans die from an overdose of prescription painkillers or heroin* – commonly referred to as opioids.

Blue Cross and Blue Shield companies are committed to our members and our communities to fight America’s opioid crisis. We are leveraging our resources and expertise within BCBS System to help to address the opioid epidemic and substance use disorder by:

  • Raising awareness of opioid risks and marshalling support for well-informed public policy through community engagements and partnerships;
  • Drawing on our unique role in the U.S. healthcare system to create a blueprint for a better system of care for substance use disorder; and
  • Adhering to nationally accepted, evidence-based guidelines in covering the care and treatment of individuals suffering from substance use disorder.

In 2016, BCBS companies increased the number of community programs related to behavioral health by a quarter, with a particular focus on addressing the opioid epidemic.

Learn more about BCBSA’s work on opioid use disorder here.

Key Issues - BlueAdvocacy

Ensuring Access to High-Quality, Affordable Care 

For more than 80 years, Blue Cross and Blue Shield companies have provided access to high-quality, affordable care in communities across the country.

A Uniquely National and Local Perspective

Unlike any other group of companies, we help ensure access to care in every ZIP code in America. We are part of our communities and give back to our communities.

Taking a Holistic View of Healthcare and Advocacy

We are leading the way on transforming the relationship between providers and payers, bringing consumers a patient-centered approach, along with greater transparency about the cost and quality of their care and working with hospitals to help improve patient safety.

Applying Our Principles to Advocacy

We work every day to advance healthcare quality, choice and affordability. We speak on behalf of those who want to build a healthier America, neighborhood by neighborhood.

BlueWorks Awards - BlueAdvocacy

The annual BlueWorks Awards program is designed to advance our mission by recognizing the single Blue Cross and Blue Shield company that best demonstrates taking a leadership role in transforming the quality, affordability and delivery of care.

The Blue Cross and Blue Shield Association’s BlueWorks® Award honors and recognizes the achievements of a single Blue Cross and Blue Shield company that best demonstrates taking a leadership role in transforming the quality, affordability and delivery of care. The winning program focuses on a significant issue that is meaningful to members and Blue Plan stakeholders, and demonstrates improvement in one of the following areas:

Empowering Consumers and Providers

Technologies or processes that deliver tools to consumers and providers to help them make more informed decisions

Promoting Health and Wellness

Programs that encourage consumers to adopt healthy lifestyles and that have shown to be beneficial to health outcomes, cost of care and overall quality of life.

Fostering Public-Private Coverage Solutions

Tailored solutions for extending coverage to those previously uninsured.

Winning entries for the BlueWorks Awards program are reviewed by a panel representing key medical societies of judges led by Barbara J. McNeil M.D., Ph.D. of the Harvard Medical School Department of Health Care Policy. The panel of judges uses a rigorous process of criteria-based evaluation to determine the program that best meets the Award criteria and makes a significant impact upon the company’s stakeholder population.

Since the inception of BlueWorks in 2004, Harvard has recognized 57 Blue Cross and/or Blue Shield Plan programs for their innovative work to help consumers better manage their healthcare choices.

Medicaid - BlueAdvocacy

Medicaid Needs Stable and Predictable Funding to Ensure Access and Improve Quality for Vulnerable Populations

Blue Cross and Blue Shield companies are leaders in serving Medicaid recipients and currently provide coverage for 6.6 million enrollees in 23 states and Puerto Rico. Through Medicaid managed care, Blue Cross and Blue Shield companies address both the social and economic issues of Medicaid enrollees, along with their physical and behavioral health needs. Managed care is now the predominant delivery system for state Medicaid programs, helping states to ensure access, improve quality and achieve budget certainty.

Through contracted arrangements with state agencies, Medicaid managed care organizations provide traditional Medicaid benefits and additional services to Medicaid enrollees. Blues Cross and Blue Shield companies have programs in place to identify the most effective ways of facilitating access to social supports, such as housing, education, job training, and other services, in a holistic and individualized approach.

As a result of chronic disease prevention and treatment programs developed by Blue Cross and Blue Shield companies, members in Medicaid managed care plans have seen measureable improvement in health outcomes.

BCBSA urges Congress and the Administration to ensure continued financial support for Medicaid medical assistance to reflect increases in the prices for medical care, growth in the volume and intensity of services per person and demographic effects such as the aging of the population, so that states can properly invest in Medicaid improvements through managed care.

Investing in America’s Health - BlueAdvocacy

Blue Cross and Blue Shield (BCBS) companies around the country collectively devoted nearly $400 million to support community health initiatives in 2014, and their employees volunteered almost 300,000 hours to community service, according to “Investing in America’s Health,” a report by the Blue Cross Blue Shield Association (BCBSA).

The sixth annual report demonstrates the 36 BCBS companies’ commitment to creating healthier communities nationwide. 

“Across every ZIP code in the U.S., nearly one in three Americans rely on Blue Cross and Blue Shield for access to safe, quality and affordable healthcare,” said Scott Serota, president and CEO of the Blue Cross Blue Shield Association. “With local roots in every community, Blue companies are uniquely positioned to create and maintain lasting partnerships with doctors, hospitals, schools and other organizations to help create stronger, healthier communities.”

By working alongside local physicians and hospitals, BCBS companies help deliver better quality and more affordable care. They provide leadership and help fund local programs that improve the health and wellness of more than 105 million members and their communities. This collective support demonstrates The Power of Blue and its three focus areas: improving access to healthcare, improving healthcare quality and affordability, and enabling healthier living.

Improving Access to Healthcare

BCBS companies are working to address a predicted shortage of tens of thousands of medical professionals by 2025. In an effort to ensure Americans have access to physicians, nurses, hospitals and other healthcare facilities, BCBS companies are investing in education and development programs for America’s healthcare workforce. BCBS companies also support local clinics that provide services in underserved areas.

Improving Healthcare Quality and Affordability

The Blues® are developing innovative tools and programs to improve the quality of care and help make it affordable for all Americans. Today, BCBS companies are leading a shift toward care delivery programs that provide incentives for better health outcomes for patients while reducing costly duplication and waste in care delivery. About one in five claim dollars are now spent in these new models, with more than 25 million BCBS members in 570 locally tailored programs that reward doctors for better coordinated care and improved health outcomes.

BCBS companies also recognize medical facilities that demonstrate proven expertise in delivering safe, effective and cost-efficient care through the Blue Distinction® program.

Additionally, BCBSA’s Center for Clinical Effectiveness assesses the effectiveness of medical devices, procedures and biological products through comprehensive reviews and clinical evidence.

Enabling Healthier Living

With a commitment to improving the health and wellness of the communities they serve, BCBS companies provide a variety of resources to organizations, schools, families and individuals to help create a healthier living environment.

A key focus is reversing the trend of childhood obesity. In collaboration with the Partnership for a Healthier America (PHA), BCBS companies in 10 cities hosted more than 72,000 people at 48 events in 2013. These events gave communities a place to play by closing roads to traffic and opening them up for families to jump, run and stay active.

BCBS companies also work alongside local chapters of national charitable organizations that share their vision of a healthier America. BCBS employees donated $9 million to community and social causes and volunteered 298,000 hours by building playgrounds, working in community gardens, bringing meals to the homeless, organizing community walks to support non-profits, mentoring students, donating blood and serving on boards.

“For 86 years, the locally operated Blue Cross and Blue Shield companies have been committed to improving health and wellness in the communities they serve,” Serota said. “They devote valuable resources to help create healthier communities — not just for members, but for every American.”

To learn more about how BCBS companies are improving the health and wellness of members and their communities through The Power of Blue, view the report at www.bcbs.com/investingincommunities.

New Blue Perspective - BlueAdvocacy

April 2014

The Blue Cross and Blue Shield Association’s BlueWorks® Award honors and recognizes the achievements of a single Blue Cross and Blue Shield company that best demonstrates taking a leadership role in transforming the quality, affordability and delivery of care. The winning program focuses on a significant issue that is meaningful to members and Blue Plan stakeholders, and demonstrates improvement in one of the following areas:

Empowering Consumers and Providers

Technologies or processes that deliver tools to consumers and providers to help them make more informed decisions. 

Promoting Health and Wellness

Programs that encourage consumers to adopt healthy lifestyles and that have shown to be beneficial to health outcomes, cost of care and overall quality of life. 

Fostering Public-Private Coverage Solutions

Tailored solutions for extending coverage to those previously uninsured. 

Winning entries for the BlueWorks Awards program are reviewed by a panel representing key medical societies of judges led by Barbara J. McNeil M.D., Ph.D. of the Harvard Medical School Department of Health Care Policy. The panel of judges uses a rigorous process of criteria-based evaluation to determine the program that best meets the Award criteria and makes a significant impact upon the company’s stakeholder population.

Since the inception of BlueWorks in 2004, Harvard has recognized 57 Blue Cross and Blue Shield Plan programs for their innovative work to help consumers better manage their healthcare choices.

Delivery System Reform - BlueAdvocacy

Changing Care Delivery is Key to Long-Term Savings and Improved Quality



The U.S. healthcare system is changing rapidly, but greater efficiency, improved care and decelerating costs are not coming fast enough.

Blue Cross and Blue Shield companies are working aggressively to improve quality and rein in costs through patient-focused care programs. These programs, customized to meet local needs, are helping to emphasize prevention, wellness, disease management, and better coordinated care. 

As a result of  programs to reform payment and advance innovative delivery models, BCBS members are experiencing fewer unnecessary ER visits, lower hospital admissions and readmissions, reduced hospital infection rates, and better health outcomes in key quality measures, including breast cancer screening, improved cholesterol control, and adherence to best practices for treating diabetes. 

BCBSA and Blue Cross and Blue Shield companies will continue to build on these successes to provide access to high-quality, affordable health care. Learn more about our successes here.

Medicare Advantage - BlueAdvocacy

Medicare Advantage Needs Stable and Predictable Funding to Protect Beneficiaries 
 

Medicare Advantage is a stable and popular program that is valued by more than 30 percent of Medicare enrollees — 19 million and growing. These beneficiaries have chosen private Medicare Advantage plans because of the patient-centered, high-quality health care services provided, as well as additional benefits not available in traditional Medicare.

MA plans outperform traditional fee-for-service Medicare on a variety of quality measures, including reduced hospital admissions and emergency room visits. Plans offer significant initiatives in primary care and preventive services, care coordination, case management and other activities designed to improve quality, with an emphasis on those with chronic conditions.

Blue Cross and Blue Shield companies collectively cover nearly three million beneficiaries in Medicare Advantage plans.

BCBSA supports adequate funding for Medicare Advantage so that beneficiaries can continue to receive affordable and attractive benefits and the MA program can continue its focus on improving outcomes for patients.

State Exchanges - BlueAdvocacy

The Affordable Care Act (ACA) creates new state-based health insurance exchanges in 2014 to help individuals and small businesses compare and enroll in health coverage. Individuals and small employers will be allowed to select from a range of health plans offered through exchanges. If a state chooses not to set up an exchange, the federal government is required by law to set up a federal exchange in their place. An up to date profile of each state’s exchange provided by the Kaiser Family Foundation can be found here.

The Federal Government and the states that have chosen to run their own exchanges are busy preparing for open enrollment. On October 1, 2013, the enrollment period will open, allowing individuals to begin shopping, selecting and purchasing insurance through the new health insurance exchanges (also known as marketplaces). This open enrollment period will last for six month, ending on March 31, 2014.

These online exchanges will have tools to help individuals calculate their monthly premiums and determine if they will qualify for financial subsidies from the Federal Government. These subsidies will help individuals pay for their health insurance premiums. If an individual purchases coverage through the exchanges prior to December 15, 2013, their coverage will start on January 1, 2014.

In 2014, the vast majority of exchange have adopted the “competitive” market-based models that provides consumers a broad choice of health plans, while a handful of exchanges have chosen an “active purchaser" exchange model that will limit what health plans are available to consumers.

BCBSA believes that consumers are best served by market-based exchanges, and the U.S. Department of Health and Human Service’s rules should continue to support this approach and also continue to give states maximum flexibility to develop exchanges that best meet local needs.

Quality and Affordability - BlueAdvocacy

Ensuring a Strong, Private Market with Competition and Choice for Consumers

For more than 80 years, the private health insurance market has provided Americans with healthcare coverage that has continuously evolved to meet consumer needs. Yet today we are at a crossroads. Although we have made great strides in expanding access to health insurance, it remains too expensive for many working, middle-income Americans who do not receive coverage through their employers. Moreover, in one-third of U.S. counties today, people who buy coverage on their own have only one choice among health insurers.  

While there are differences on the best approach, most agree that Americans are best served by a competitive, private health insurance market that offers consumers the choices they want at a price they can afford. Further, healthcare coverage must be accessible to as many Americans as possible, with more choices and better prices. 

To achieve that end, we support actions to: 

  • Address the immediate priorities that will help keep premiums stable and allow people to keep their coverage; 
  • Return regulatory authority for insurance to the states so that they can put in place reforms that work for them; and
  • Cut back regulations and fees that add costs without value.

BCBSA is committed to working with Congress and the Administration to advance a stable and affordable private insurance market. 

Affordable Health Benefits - BlueAdvocacy

Issue:
The Affordable Care Act includes a broad expansion of required benefits. As a result, millions of Americans will have coverage that is more comprehensive than they had previously purchased. The U.S. Department of Health and Human Services has issued the requirements for all health insurance products sold in the individual and small group markets to provide a minimum set of benefits called “Essential Health Benefits” (EHB) starting in 2014.

The “essential health benefits” package covers ten categories of services:

Click to enlarge
  • Outpatient services

  • Emergency services

  • Hospitalization

  • Maternity and newborn care

  • Mental health and substance abuse disorder services, including behavioral health treatment

  • Prescription drugs

  • Rehabilitative and habilitative services and devices

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services, including oral and vision care

In addition, all health insurance policies will also be required to meet a minimum “actuarial value” of 60 percent—meaning the policy will have to cover at least 60 percent of the expected health care costs of the average beneficiary.

Position:
The Blue Cross and Blue Shield Association believes the EHB package must balance the need to provide appropriate, high-quality coverage with the need to ensure that such coverage is affordable for small employers and individuals. BCBSA recommends that the EHB package be affordable, evidence-based and allow flexibility to meet the needs of consumers and small employers.


Essential Health Benefits Must Still Maintain Affordability For Consumers
Understanding how the various EHB provisions affect health insurance premiums is crucial to assessing whether coverage is broadly affordable. The specific impact of these requirements on health plan premiums will vary considerably based on an individual’s age, income, geographic location, health-status, and other factors.

The U.S. Department of Health and Human Services has reported that many individuals and families purchasing coverage on their own do not currently have coverage for some of these newly provided services, such as maternity services (62 percent), substance abuse services (34 percent), mental health services (18 percent), and prescription drugs (nine percent).

A new report from Milliman, Inc. helps explain how the Affordable Care Act’s (ACA) coverage expansion, new benefits, and market reforms will impact individual market health insurance premiums in 2014. The report highlights how some provisions will increase premiums while others will make health care coverage more affordable for consumers. Milliman estimates that the inclusion of these new EHB’s in new health insurance plans will cause premium increases in the 3% to 17% range for consumers.

Broad Coalition Supports Efforts To Make Essential Health Benefits Affordable
The Blue Cross and Blue Shield Association is a member of the Affordable Health Benefits Coalition (AHBC). The AHBC is a broad-based organization representing large and small employers from various sectors of the U.S. economy, including pharmacy benefit managers, health insurance agents, providers and health plans operating in every zip code.

The coalition is committed to keeping the cost of health care coverage affordable and has made 6 recommendations that will help to keep insurance coverage affordable, even with these new benefits.

The Blue Cross and Blue Shield Association is committed to providing high quality, affordable health insurance for our members. While the new requirements may make coverage less expensive and more affordable for some, they will also make coverage more costly and less affordable for others. Assuring broad participation, especially among younger individuals who may be particularly price sensitive and less likely to purchase coverage as premiums increase, will help keep costs down which is critical to the long-term success and sustainability of the new health insurance exchanges and broader health care insurance market.

Resources:

 Affordable Health Benefits Coalition Will Advance Commonsense Ideas to Address Health Care Affordability

Investopedia: Lowering Your Costs For Marketplace Health Insurance Coverage

 America’s Health Insurance Plans Fact Check: Essential Health Benefits

Milliman Report: Comprehensive Assessment of ACA Factors That Will Affect Individual Market Premiums in 2014

Kaiser Health News: Feds Outline What Insurers Must Cover, Down To Polyp Removal

Drug Pricing - BlueAdvocacy

Ensuring Access to Safe, Effective and Affordable Medications and Treatment Options

Groundbreaking medicines continue to enter the marketplace and improve the lives of patients. But spending on prescription drugs has also increased substantially, representing as much as 20 percent of health insurance premiums. In total, drug spending is projected to rise more quickly than overall healthcare spending over the next several years – an unsustainable path.

BCBSA supports a robust, competitive prescription drug market that continues to promote innovations that ensure people have timely access to safe, effective, cutting-edge prescription medicines and their generic equivalents at the most affordable price. We also support greater transparency and sharing of information on prescription pricing and providing all participants in the healthcare industry, including medical professionals, with the tools they need.

BCBSA believes everyone should have access to safe, effective and affordable treatment options and is committed to helping Americans manage their health in ways that improve outcomes and lower costs.

Learn more about drug pricing reform here.

Privacy Policy - BlueAdvocacy

Your privacy is important to us. The Blue Cross and Blue Shield Association ("BCBSA") maintains high standards for the protection of your privacy at our web sites. Here is what you can expect when you visit BlueAdvocacy.org:

Other than to fulfill a request from you, we won't sell, rent or share any personally-identifiable information you provide without your consent.

No personally-identifiable information collected at this site will ever be used to affect your health insurance coverage by or premiums paid to a Blue Cross and Blue Shield Company.

PLEASE REMEMBER that this policy covers only the data collection and use practices for BlueAdvocacy.org, an official Web site of the Blue Cross and Blue Shield Association. BCBSA's privacy policies may differ at other of its websites or in its off-line data collection and reporting practices. Questions regarding the privacy policy of your independent, local Blue Cross and Blue Shield company should be directed to that company.

The Information We Collect

Our Web servers automatically capture your domain name, the IP address of the web page from which you enter our site, the pages you visit on our site and the amount of time you spend here. We do not collect any information that can reveal your personal identity unless you voluntarily provide it when you register to use interactive features of the site, including the Activist Central area, or to receive information from us or our member Blue Cross and Blue Shield companies ("Blue Plans"). The information we collect is not part of any designated record set. Personally identifiable information voluntarily provided by you may be retained indefinitely for the purposes described in this Privacy Notice.

Use of the Information this Site Gathers/Tracks

When you use http://www.blueadvocacy.org to write your elected official, we will collect your name, address, ZIP code and telephone number for the purpose of identifying your congressional district and confirming that you are a constituent to the recipient of your letter to Congress. Many congressional offices have enough staff resources to respond only to constituents, and this will help identify you as such.

If you choose to write a letter to your elected representative and then affirmatively check a box that says "remember me," a "cookie" will be used to store your user ID and password on your local machine in order to save you time. If you wish to prevent this cookie from being set to your hard drive, do not check the "remember me" box. If you decide to join our list, we will collect your email address, name, and mailing address and send you updates on initiatives by email or U.S. mail. We will do our best to respect both your time and attention. If you choose to share your story with us, we will not disclose your personal information without your explicit permission and consent, except to the congressional offices to which you have addressed your correspondence and to BCBSA and its plans. Your information also will be available to our Web site vendor for the purpose of assisting us with administering and operating this web site. We realize that you may be concerned about providing demographic information. For this reason, the Web site vendor for BlueAdvocacy.org takes precautions to protect the data you provide. The data is housed on secure servers which are physically guarded 24-hours a day in a restricted access building. The data is backed-up as part of a nightly security routine to prevent loss, misuse or alteration.

You may cancel your subscription and opt out of future communications at any time by sending a message to BCBSA_list@capwiz.mailmanager.net with the word 'unsubscribe' in the subject line. You may also return to this site at any time to correct or update your information.

Children

Under 13: We do not knowingly collect information from children under 13 years of age. You must be at least 13 years old in order to use BlueAdvocacy.org. If you are under 13 years of age, please do not send any information about yourself, including your name, address or e-mail address. If we discover that we have collected any personally-identifying information from a child under the age of 13, we will remove that information from our database as soon as possible.

Links to Other Sites

BlueAdvocacy.org contains links to other sites that may not follow the same privacy policies as this site. These sites may use cookies, collect data, and use the data in ways that Blue AdvocacySM would not. We are not responsible for the privacy practices or any information or materials on these other sites. Please visit these sites if you wish to review their privacy policies.

Changes to This Policy

We reserve the right to change this policy. If we make any changes to this policy, we'll let you know the effective date of the changes and you can contact our Webmaster if you'd like to know more about what's new. If you have any questions or comments or receive any unwanted e-mail from this site, please contact our Webmaster via e-mail at blueadvocacy@blueadvocacy.org.

Acceptance of Privacy Policy Terms

Any changes to this policy will be posted to this page as soon as reasonably possible, so please check this page periodically. Use of this Web site constitutes consent to the privacy policy then in effect.

New and Events - BlueAdvocacy

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Stay up to date with the latest Blue Cross Blue Shield Association headlines: 

Resources - BlueAdvocacy

The Blue Cross Blue Shield Association is committed to being a leading voice for consumers as we deliver high-quality healthcare for our customers. Visit these key resources to learn how the Blue Cross Blue Shield Association is working for you.

AskBlue Educates Consumers about Buying Health Insurance

AskBlue® is a newly redesigned website created by BCBSA that answers questions about how to buy health insurance and helps people get health insurance that fits their healthcare and financial needs, whatever they may be.

To learn how it works, visit AskBlue® and see for yourself.

The Power of Blue: Creating Healthier Communities

For more than 80 years, we have worked with local communities to deliver better quality and more affordable care. We provide leadership and help fund local programs that improve the health and wellness of our members and their communities. Find out what your local plan is doing in your community and see The Power of Blue.

Blue Distinction Centers

The hospital you select can have a direct impact on the care you receive and your procedure results. But finding the right hospital can sometimes be a challenge.

That’s why we developed the Blue Distinction Centers® recognition program to identify hospitals with proven expertise and efficiency in delivering specialty care. Find out more about this innovative program at www.bcbs.com/bluedistinction.

About Us - BlueAdvocacy

The Blue Cross and Blue Shield System


For 86 years, Blue Cross and Blue Shield (BCBS) companies have provided secure and stable healthcare coverage to people in communities across the country. BCBS grew out of a grassroots approach to a prepaid hospital plan in 1929. Today, the 36 independent and locally operated BCBS companies offer a personalized approach to healthcare based on the local needs of the communities where members live and work.

More than 106 million people — nearly one-in-three Americans — rely on BCBS companies for healthcare coverage. Learn more by reading Blue Facts