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Blue Cross NC, Duke Health Launch New Health Plan for Triangle Seniors

April 30, 2019

Two pillars of the North Carolina healthcare sphere are teaming up to focus on an underserved segment of the Triangle’s population, and they intend to play off each other’s strengths to do it.

In an announcement released earlier this month, Blue Cross and Blue Shield of NC and Duke University Health System said they are coming together to create Experience Health—a new health insurance company aimed at meeting the needs of local senior citizens.

Blue Cross NC has indicated the use of advanced data and analytics tools will help augment patient care, leading to better outcomes for those who battle chronic conditions like diabetes. The new jointly owned and locally operated company will emphasize enhanced communication, encouraging better relationships between patients and physicians so patients have treatment goals and plans that are easier to understand.

Experience Health is also setting its sights on tweaking healthcare in areas that have often resulted in frustrating experiences for patients. The non-profit health plan will attempt to facilitate prompt access to healthcare professionals and strive to simplify processes around appointments and billing. All of the proposed improvements contribute to what the plan is calling team-based care.

While the accessibility to healthcare is certainly an important piece of the puzzle, patients will be equally as interested in learning more about the associated costs involved with the plan.

Rising costs in healthcare are one of the most critical issues in our advocacy. We recently brought you news that Americans borrowed $88 billion in the past year to cover the cost of their healthcare, and we know patients are asking for less expensive drugs and are either skipping or reducing doses in order to make them last longer.

In the announcement distributed by Blue Cross NC, the company said Experience Health is committed to developing affordable and accessible products and services. Patrick Conway, MD, President and CEO of Blue Cross NC, also referred to the new plan as “another example of our desire to collaborate closely with the state’s leading health systems to improve quality, lower costs, and deliver exceptional experience.”

Members of the plan will be the recipients of core-strength services supplied by each half of the partnership. Blue Cross NC will provide enrollment, billing, and claims services to customers, while Duke Health will offer comprehensive medical services that include population health management programs designed to improve the health of the entire Triangle region.

That operational split also extends to the boardroom as three members from each company will govern the company as its board of directors. Mark Waggoner, a seasoned healthcare executive and former Blue Cross Rhode Island leader, will head the new company.

Pending approval by the Centers for Medicare and Medicaid Services of an already filed application, Experience Health is expecting to launch a Medicare Advantage plan beginning in 2020. As of now, the counties served by the plan will include Alamance, Durham, Franklin, Granville, Lee, Orange, Person, Vance, and Wake.

Assuming there are no snags with the approval, Experience Health will be an option during the Medicare Annual Enrollment Period starting in the fall of 2019.

Have the sky-high costs of healthcare in our state impacted you and/or your family’s lives? Do you want to do something about it? Join the Coalition now to receive updates about new legislation and policies that will affect YOUR healthcare. ​


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