Craig Humphrey President & COO FirstCarolinaCare Insurance Company
What are the advantages of being a health insurance company owned by a health system? We were designed to offer community members local health insurance that wouldn’t leave anyone behind. We created products that initially the hospital would help subsidize for a lot of the small employers, employers with 25 people and under, who really were not offering health insurance at the time. We don’t have shareholders like our national peers do, so the dollars we spend on healthcare stay in the community. We also partner with other provider groups, so even though we may be owned by two hospital systems, we really have brought a lot of the medical community together to participate in our quality initiatives. This elevates the level of care for the member because we partner with their doctor to ensure that the focus is on finding areas of shared value and opportunities for innovation that improve outcomes. What is your view of price transparency? Health insurance has been focused on transparency for a number of years. Members are able to go to their plan website and get an estimate of their out-of-pocket cost for care. Since the start of this year, transparency in pricing has been introduced at all hospitals, so that is a good next step. I think the real issue is that healthcare can be complex. Because healthcare is complex, it makes health insurance very complex. The average person doesn’t really understand their insurance benefits. They know they have insurance and they will typically refer to it by the name of the insurers but they don’t understand what that means. In recent years, so many folks chose to move into high deductible health plans, which are great for those who tend to be healthy but one must remember that this is not a great product for everyone. We’re working with employers to do a better job building education, encouraging them to inform their employees about what their benefits are. Part of this education is understanding the value of using participating providers in their insurance plan network. That understanding leads to more transparency. 128
| Invest: Raleigh-Durham 2021 | HEALTHCARE
( ) Immediately in March 2020, Duke Health, WakeMed and UNC Health all announced they would be delaying elective surgeries to conserve supplies for the fight against the pandemic. By October, the hospitals were readmitting elective procedures but had to fight through a huge backlog. The problem was exacerbated by serious health problems that had emerged during the pandemic as people became reluctant to seek help from care providers at the height of lockdown. The financial impact of this reduction in elective procedure volume is estimated to have caused $200 billion in financial losses for hospitals and health systems nationwide between March and June 2020. According to McKinsey, it could take up to two years for hospitals to work through the backlogs. The situation was further complicated at the beginning of 2021 when hospitals began to fill up again amid critical staffing shortages. North Carolina hospitals, including WakeMed, began to once again review their surgical schedules to find ways to push procedures back, especially those requiring inpatient stays. UNC REX stopped scheduling orthopedic and bariatric procedures and most life-changing gender reassignment surgeries for transgender patients were also pushed back. The main issue facing hospitals, rather than availability of beds and supplies, continues to be staff shortages. Even with more beds, the already-stretched hospital staff would be unable to maintain them, experts believe. Notable developments Although the Triangle’s health systems were put under pressure by the pandemic, research institutions were eager to step up to the plate and help with the testing and vaccination efforts. In January 2021, pharmaceutical firm Novavax delivered promising phase 3 clinical trial results after Raleigh-based Wake Research Associates enrolled 2,000 of the almost 30,000 trial volunteers. Overall, the firm has enrolled 6,000 people in COVID-19 vaccine trials. And even earlier, prior to approval of the Pfizer and Moderna vaccines, Durham refrigeration technology company Phononic was approached to discuss distribution efforts. The Pfizer vaccine requires storage at -80°C to -60°C, requiring highly specialized storage and distribution networks. As with any crisis, the pandemic created both challenges and opportunities for companies. Raleigh-based insurer and physician services firm Curi announced in April 2021 that it would acquire Charlotte-based analytics company Arrowlytics in a push to expand its services. And Bain-backed, Raleigh-based behavioral health firm Broadstep Behavioral Health in June acquired a portion of Wisconsin-based Bethesda Lutheran Communities’
