Todd Shamash is president and CEO of Capital Blue Cross.
As a company founded in Harrisburg nearly 90 years ago, Capital Blue Cross has always had a vested interest in the health and well-being of this community. We’re proud to do our part to help make the Harrisburg region a great place to live, work, and raise families.
Central Pennsylvania, like so many areas of the country, struggles to ensure everyone has access to affordable, quality healthcare that can help them enjoy fulfilling, productive lives.
So why is healthcare so expensive?
There are a lot of factors driving healthcare costs, but let’s look at how Capital Blue Cross is effectively addressing three major ones: how services are paid for, how chronic illnesses like diabetes and heart disease are treated, and the growing demand for prescription drugs.
Capital Promotes a Better Healthcare Payment Model
Healthcare providers, whether it’s a hospital or your family doctor, are often paid based on the number of tests and treatments provided rather than the quality and effectiveness of those services. But what if they were paid based on whether your health actually improved?
Capital advocates a payment model that rewards healthcare providers based on how much they help patients improve or maintain their health. Our model looks at factors that historically were often absent from the payment equation—quality of care, patient satisfaction, and appropriate cost. And we look at data on the effectiveness of care to continually find ways to further improve care.
The end result is more effective care at lower costs.
Capital Helps Manage Chronic Illnesses
Odds are you or someone you know has diabetes, heart disease, or another chronic condition that requires ongoing monitoring and care. In fact, 6 in 10 Americans are living with at least one chronic disease.
The complexity and cost of treating chronic illnesses continues to rise in part because traditional care models can sometimes lack the coordinated care and proactive support patients need.
Capital is working to fix this. We have care teams that focus on coordinating care and engaging our members with chronic illnesses to help improve their health outcomes and reduce costs of care without compromising the quality of care. We also work closely with our network provider and health systems to strengthen traditional care models.
We also promote a concept of “whole-person care,” which takes into account all the social and economic factors that might be impacting a person’s well-being. For instance, if someone dealing with a chronic illness has difficulty affording medications or arranging transportation to a doctor, we look at ways to overcome those challenges so they can get the care they need.
Capital is Making Prescription Drugs More Affordable
Nearly half of Americans routinely take a prescription medication and spending on retail prescription drugs has steadily increased for decades. The cost of these drugs can lead some to stop taking necessary medications, putting their health at risk.
Capital Blue Cross has proven programs to rein in drug costs. For businesses that have Capital coverage for their employees, we’ve managed to lower the cost of expensive specialty drugs that treat conditions like arthritis, psoriasis, and Crohn’s Disease. Our strategies saved those employers more than $11 million in 2024, while also saving the employees thousands of dollars annually.
We also were the first health insurer in the nation to work with Mark Cuban Cost Plus Drugs to help people save on their prescriptions, helping our members get dramatic savings on critical prescriptions. Cost Plus Drugs has a simple, transparent cost formula on hundreds of commonly used medications to treat everything from high blood pressure to diabetes to mental health.
We know there will continue to be challenges in addressing the cost and access to healthcare, but Capital is continually looking at ways to proactively address these challenges. As a locally based and not-for-profit insurer, It’s part of our commitment to go the extra mile for Harrisburg and all the communities we call home.
Todd Shamash is president and CEO of Capital Blue Cross. For more information, visit www.capbluecross.com. This article is sponsored content.
If you like what we do, please support our work. Become a Friend of TheBurg!
