Managing the rising costs of health care

Health care costs are on a relentless rise. For many people, this could mean delaying a visit to their doctor or skipping doses of prescribed medication because of cost concerns. People shouldn’t be forced to choose between basic needs like food and gas to get the health care they need.

As a nonprofit health plan, we aren’t beholden to shareholders, we’re committed to the health and well-being of the people we serve across Idaho, Oregon, Utah and Washington. Ensuring our members have access to high-quality, affordable health care will always be a top priority. And while we can’t solve the health care affordability crisis alone, we’re working every day to help manage rising costs.

Negotiating with health care providers

We negotiate the cost of care with health systems – clinics, hospitals and the like – on behalf of the 3.4 million people we serve. Not all insurance companies pay health care providers the same. We can negotiate favorable rates and help keep member costs in check because we represent a lot of people. Our premiums are based on what we expect care to cost. When the cost of doctors, hospital stays and medication goes up, so does the cost of health insurance. That’s why we advocate for a balance in fairly compensating doctors and nurses for the critical care they provide, while standing up to health systems that demand unsustainable, double-digit rate increases.

Identifying appropriate sites-of-care

We help evaluate the most appropriate setting for care whether it’s an ambulatory surgical center, a doctor’s office or even your own home. This could mean directing members out of expensive hospital settings to more affordable places for certain treatments without sacrificing the quality of care.

Combatting increasing drug prices

We’re a national leader in developing programs to rein in specialty drug spending. We help members switch from expensive brand name specialty drugs to less expensive generic alternatives called biosimilars. We’ve converted 95% of the therapies that have an available biosimilar, saving more than $37 million a year. Like with hospitals and clinics, we also partner with many pharmacies to negotiate preferred rates for our members.

Focusing on preventive care

Keeping up with preventive care and chronic condition management helps keep people healthy and avoid costly treatments down the line. Preventive care such as annual health exams, screening procedures and vaccines with in-network providers are generally covered at no cost to members.