What Are We Doing To Help Control Health Care Costs?

By Shauna Vistad

Yesterday’s blog looked at research showing that nearly a third of health care costs may be attributable to fraud, waste or abuse, which amounted to an estimated $765 billion in 2009.

BCBSND has a Special Investigations Unit (SIU) responsible for the prevention, detection, investigation and resolution of suspected health care fraud, waste and abuse. The SIU uses tips, reports, claims pattern analysis and proactive investigations to identify areas of concern, conduct investigations and take appropriate actions to recover any identified improper payments.

Here’s what Blue Cross Blue Shield of North Dakota (BCBSND) is doing to fight fraud, waste and abuse:

  • Controlling administrative costs. BCBSND’s administrative costs are among the lowest in the nation, take a look at how your premium dollar is spent.
  • Making insurance affordable with more options to help encourage members to have a more active role in caring for their health as well as a better understanding of health care costs. BCBSND is offering a wider variety of options including consumer-driven health plans, sometimes referred to as high deductable health plans.
  • Working with providers to negotiate competitive rates, focusing on quality over quantity and offering tools such as MediQHome to ensure patients receive the right care at the right time.

(This is the second in a three-part series of blogs about fraud, waste and abuse in the health care system. Tomorrow’s blog will focus on what you can do as a consumer to help control costs).

Shauna Vistad, Certified Fraud Examiner (CFE) and Certified Forensic Interviewer (CFI), is manager of the Special Investigations Unit (SIU) at BCBSND.