North Carolina policymakers should begin to emphasize the importance of getting value for our health care dollar.

To that end we should implement three interrelated strategies that are first steps toward providing better value:

  • Establishing an all payer claims database
  • Expanding rate review powers of the NC Department of Insurance
  • Update and expand North Carolina’s network adequacy laws.

Health care costs and health insurance premiums are growing at a rate faster than the rest of the economy, straining the bank accounts of hard-working families. North Carolina and its citizens do not have enough tools to address these rising costs. Consumer tests find people are angry about health care costs and do not feel they are getting good value for their dollar. They also feel powerless to address these problems. These recommendations empower consumers and provide protection from unexpected cost increases.

An all payer claims database collects claims data from all insurers, public and private, on the theory that we can’t improve value in our health spending if we can’t measure it.1 Coupled with stronger rate review authority, the NC Department of Insurance could use the all payer claims database to create greater transparency and more accountability.2 3

Network adequacy is the ability of health plan provider networks to deliver the right care, at the right time, without enrollees having to travel too far.4 5  North Carolina has network adequacy laws that apply to HMO, but not PPO, plans. North Carolina should update and expand its network adequacy laws to ensure consumers have access to doctors and hospitals. The state of California has the strongest measures of protection for consumers, requiring that an insurance plan have a certain number of providers within a certain distance or travel time from a consumer.6

Blue Cross Blue Shield of North Carolina has made efforts to give consumers more access to information about costs.7 The state can follow that example and put these proposals into place, giving consumers and regulators more power to check rising health care costs and insurance rates. In order to be personally responsible, consumers should have access to the information to help them make wise decisions

1 Green, Linda, Amy Lischko, and Tanya Bernstein. (January 2014). Realizing the Potential of All-Payer Claims Databases. Robert Wood Johnson Foundation.

2 Karaca-Mandic, Pinar, Brent D. Fulton, Ann Hollingshead and Richard M. Scheffler. (August 2015). "States With Stronger Health Insurance Rate Review Authority Experienced Lower Premiums In The Individual Market In 2010–13." Health Affairs.

3 Consumers Union. (June 2015). Health Insurance Rate Review: A Powerful Tool for Addressing Consumer Health Costs.

4 Hoadley J, Ahn S, and Lucia K. (June 2015). Balance Billing: How Are States Protecting Consumers from Unexpected Charges? Georgetown University Health Policy Institute

5 Health Management Associates. (November 2014). Ensuring Consumers Access to Care. Robert Wood Johnson Foundation.

6 State Health Reform Assistance Network. (August 2013). ACA Implications for State Network Adequacy Standards. Robert Wood Johnson Foundation.

7 Blue Cross Blue Shield of North Carolina. "Health Care Cost Estimator.