BCBSNC Foundation Targets Long-Term Gains in Youth Mental Health, Nutrition, and Care Access: Colleen Briggs, MBA

In part 2 of her interview with The American Journal of Managed Care^® (AJMC^®), Colleen Briggs, MBA, president of the Blue Cross and Blue Shield of North Carolina (BCBSNC) Foundation, outlines the organization’s work across its 3 focus areas: youth mental health, health through food, and access to care.

As the Foundation marks its 25th anniversary, she concludes by reflecting on what success could look like over the next 25 years.

Read part 1 here.

AJMC: Shifting to the focus areas, starting with youth mental health, now widely viewed as a national crisis, how is the Foundation evolving its approach to strengthen prevention and early intervention?

Briggs: We toured all 100 counties of North Carolina, and we heard this consistent theme: the youth in the state felt lost and they lacked purpose. What that manifested into is increased anxiety and depression, and we see that in the data. Four in 10 high school students in North Carolina report feeling sad or hopeless or lacking a sense of purpose. One in 5 teens has considered suicide, and yet so many of these children have nowhere to turn.

More than 60 counties in our state don't even have a child or adolescent psychiatrist, so what that means is that these families have few places to go other than an emergency department or high-cost facilities, which cost more and result in worse health outcomes. This actually drives up costs for everyone in the health care system, and it means our children are not getting the support they need to be successful.

Where we came in is to be responsive to that in 3 ways. The first is, how do we get access to high-quality mental health services for everyone? The second is, how do you build those community supports that are going to support mental health? The third is, how do we strengthen that early intervention and prevention? What we heard is that we have to start earlier to address these issues before they become a crisis.

Some examples of what we're doing are integrating screenings and prevention support in pediatric settings, and we're doing that in partnership with NC-PAL. Through this new operating model, we’re also bringing our creative reimbursement strategies to integrate high-quality mental health into pediatric settings. This is really important because what we've seen is that in so many of these counties, pediatricians are often the only line of care for youth mental health. By being able to pair both the grantmaking and our products and services as a way to help advance this model, it's a way that we can help advance some of these preventive care measures.

We're also doing the same in school systems. We've heard that kids are more than 6 times as likely to accept mental health services if they’re provided in a school setting. So, we are expanding mental health prevention, training, and support into schools so that teachers have the support they need to spot the signs and the symptoms of a mental health challenge and then get children the support they need early, before it escalates into a crisis.

AJMC: Access to care remains a persistent challenge, particularly in rural areas. What innovative strategies are you prioritizing to close these gaps?

Briggs: Access to care is so essential for the health and well-being of not only our customers but also for communities. In North Carolina, particularly in some of the rural areas, we know that there are some persistent barriers that prevent individuals from just getting the right care at the right time. What that leads to is delayed care, worse health outcomes, and higher costs, not only for them but for everyone.

We have an enterprisewide commitment to help expand access to trusted, affordable, prevention-focused care that's going to improve health and well-being in rural and underserved communities. We're really focused on promoting coverage that is easier, more affordable, and actually enables more individuals to get access to that preventive care. We're also increasing and improving the places that people receive care. Finally, we're building trust so that people can more easily engage and just stay connected with the right care.

A good example of this is our partnership and support for community health workers. Community health workers really are uniquely positioned as trusted professionals who help communities understand health risks, prevent disease, and connect individuals with some of the supports they need that are going to address some of these barriers.

We've partnered with the North Carolina Community Health Worker Association to really help expand and strengthen the community health workers so that they can address chronic conditions and create a path to improve access to care and affordability. This is just one example of many ways that we are working with groups across the state to make sure that everyone can get the right care that they need when they need it to ultimately improve their health but also drive affordability for the entire state.

AJMC: "Health through food" is an increasingly important focus area. Amid the ongoing obesity epidemic and evolving dietary guidance, how is the Foundation working to better integrate nutrition into broader health system transformation efforts?

Briggs: Very similar to some of our other signature initiatives, this one emerged as one of the top issues that we continue to hear from communities and our research that continues to say the same thing: diet-related chronic conditions are among the top drivers for poor health outcomes but also for rising health care costs. For example, diet-related chronic conditions are one of the biggest cost drivers in North Carolina; we expect it's going to cost roughly $65 billion in medical costs over the next few years in North Carolina.

As we know, so often care starts too late. Many of these chronic conditions could be better managed or prevented with lifestyle changes, including improving diets. But so often, by the time treatment begins, we're already behind medically and financially. That's really why we as a company have come together to launch this new companywide initiative that moves upstream to solve these kinds of medical challenges before they start, with a focus on how we leverage healthy food to prevent, manage, and treat diet-related chronic conditions and disease.

It’s a 3-part strategy. The first one is, how do we help individuals get the skills they need to actually eat healthier? An example of that is we have teaching kitchens at our neighborhood centers that actually bring cooking classes directly into communities so individuals can build the skills and confidence they need to eat healthier.

The second part of the strategy is integrating “food is medicine” into health care delivery. We've partnered with “food is medicine” nonprofits to test, learn, and scale effective “food is medicine” programs. Based on these lessons, the business was able to bring this to our members, and now we're offering a no-cost food prescription program that's paired with nutrition coaching for our members with uncontrolled type 2 diabetes. What we're seeing is huge improvements in health and cost savings. Importantly, we also make sure that food is sourced locally, so in addition to those health benefits, we're also supporting some of the local economies.

The third part is that we have to make sure that individuals have access to healthy food. More than 1 in 7 North Carolinians lack access to nutritious food, so we are partnering with local farmers and community groups to expand access to affordable, healthy food, no matter where you live.

All of this shows sort of an enterprisewide approach that if we want health care to be more affordable and effective, we have to address the conditions that are shaping someone's health, and that starts with nutrition. Nutrition has to be part of the solution so that we ultimately can address these pervasive issues like diet-related chronic conditions and drive down costs for everyone.

AJMC: Looking ahead to the next 25 years, what would success look like for the Foundation?

Briggs: Success for the next 25 years would mean that communities across North Carolina are healthier because the health systems around them work better and that the health systems are designed to prevent illness, respond earlier, and make it easier to access and navigate. It would mean that more families have the resources they need to avoid some of those preventable crises and that individuals, regardless of where they live, have access to healthy food so they can live healthier lives. Also, that children have the tools they need to be mentally healthy and thrive, that everyone could get affordable care they need when they need it, and that we start to rebuild trust so that people feel seen and respected and supported by the health system and they're willing to get care earlier and follow guidance and engage in preventive efforts.

I think all this together is just a hope that our work can help North Carolina move closer to a future where everyone, regardless of where they live, has the real opportunity to be healthier and that they have confidence that the health system is designed to support their needs. Ultimately, what that would mean is that North Carolina would be one of the healthiest states in the nation in a generation. That vision has guided the last 25 years, and it's the commitment that's really driving our work ahead as well.