As the Affordable Care Act (ACA) continues to unfold, insurance providers and businesses, particularly small to medium sized businesses, continue to adjust. Making decisions that best serve both the bottom line and employees requires knowledge and flexibility. Morgan Kendrick, President, Blue Cross and Blue Shield of Georgia (BCBSGa), acknowledges that the ACA is a response to health care costs that had risen to an untenable level. Because the ACA requires more comprehensive benefit plans, “ACA compliant products are typically more expensive than products people had in place before ACA. We moved from an underwriting mechanism to a community rated perspective,” he says, adding that businesses need to “truly understand what their options are.”

Blue Cross and Blue Shield is Georgia’s oldest and largest health insurance provider and hosts Georgia’s largest provider network. Founded in 1937, BCBSGa has evolved as Georgia’s healthcare industry and small business backbone have grown and changed. Its 3,000 Georgia associates have turned attention to counseling individuals and businesses in selecting insurance products that best fit their needs. Kendrick gives an overview of the choices, explaining that companies and individuals can (1) stick with “legacy” products, which are those that have been grandfathered in since enactment of ACA, (2) purchase ACA compliant products outside of the exchange, (3) purchase products through the healthcare exchange, or (4) invest in alternative strategies such as self-funding or purchasing products from a private exchange.

Without the advice of a seasoned insurance broker, sorting through the pros and cons of each option can tax the time and resources of a small to midsized business. With rising costs and confusing choices, negatives swell, but Kendrick notes some positive outcomes of ACA. “It’s really changed the focus to discussing how to think differently about how we finance healthcare,” he says. One innovation enacted by BCBSGa is the Enhanced Personal Health Care Program. The intent of the program is to bring down costs by redesigning the current payment model to move from volume-based payment to value-based payment. Kendrick says, “We want to complement the relationship between the patient and the physician,” with the idea being that better care leads to better overall health.

A second innovation rolled out by BCBSGa is the Accountable Care Organization (ACO). A partnership between the state’s largest health insurance provider and the state’s largest healthcare provider – Emory Healthcare – seeks to reduce costs by improving the delivery model, again transforming it from volume-based to value-based. For BCBSGa members, it’s a winning collaboration that enables their physicians to spend more time meeting patient needs while being properly compensated for their expertise, improves treatment results and lowers the costs of healthcare. Kendrick says, “You’ve got real skin in the game by the provider and the payer to lower costs and deliver better outcomes.”

Both innovations represent BCBSGa’s concerted attempt to shift the current approaches for paying for healthcare toward methods that will relieve the steep financial burden on customers while also enhancing their experience. Over time, as the impact of these innovations becomes measurable, the benefits will likely extend to more of BCBSGa’s 3 million members, including the 650,000 state employees and retirees served through the Department of Community Health’s State Health Benefit Plan (SHBP). “We serve at the pleasure of our customers,” notes Kendrick. “We have to bring demonstrable value.”

Additional efforts to lower healthcare costs through education and intervention improve the general health of Georgia’s citizenry.  Kendrick says, “We’re a large organization that puts our scale and size to philanthropic use in Georgia.” BCBSGa and the Blue Cross and Blue Shield Foundation identify the health issues predominantly affecting the state then direct charitable giving of financial support and volunteer hours to empower organizations addressing those needs. Using a State Health Index, which is a compilation of public health measures, and disseminating funds through the Healthy Generations grant program, BCBSGa donated $2.3 million in 2013 to promotion of active lifestyles and reduction of the impact of chronic illnesses, such as diabetes, heart disease and lung disease in Georgia.

Due to the enormity of the ACA bill, the unpacking of it isn’t complete. Proponents and opponents of the comprehensive and sweeping measure still learn new information about its contents. Much of that remains to be dissected. In the meantime, however, insurance companies like BCBSGa have begun to think critically about the best ways to move all aspects of healthcare forward – how it’s paid for, how it’s provided, how its costs are controlled – and to respond with innovations and outreach to attain positive results for payers, physicians, patients and communities across Georgia.