How You Can Support Your Team with the Rise of Health Care Costs (PART III)

Posted on October 22, 2024

Excellus BCBS logo

Excellus BlueCross BlueShield is back with Part Three in its series.

With Open Enrollment coming up this fall, we wanted to dive deeper into what goes into the premium rates that employers and employees pay. There are a lot of different factors that go into premium payments, while trying to keep health care as affordable as possible.

What goes into determining a premium rate change?
It really varies based on many factors, but the main items we consider when determining premiums for fully insured plans are:

  • (UNIT) COST. These are the fees for care and services that health insurers negotiate with hospitals, physicians, pharmacies, and other health care providers. This also includes the increasing prices of prescription drugs and durable medical equipment.
  • UTILIZATION. This is the number of medical services and prescription drugs people use. When more people use more medical services, costs can increase.
  • INTENSITY. This is when a treatment or procedure is replaced by a more expensive one. New treatments and new drugs typically cost more.  
  • ADMINISTRATIVE costs are the normal expenses needed to run a health insurance business, including the costs associated with processing claims; providing customer service; maintaining a clinical staff to support navigation of care; processing enrollment and billing; and paying government taxes/fees.

In 2023, Excellus BlueCross BlueShield used 93% of premium dollars on patient care including medical and pharmacy claims, and activities that improve the quality of care. Premium increases are primarily driven by the increases in the cost, utilization, and intensity of services used by our members.

Maintaining quality while combatting rising costs
We have a variety of innovative programs that focus on the care of our members, while also helping to control costs. We offer services to help manage costs related to medications, chronic conditions, overall wellbeing, and more, including:

Pharmacy Programs: All our fully insured plans include programs aimed at helping members get the care they need while keeping costs down, including home delivery, site of care programs, and Pharmacy Concierge. Many programs are also available to Self-Funded plans for no additional cost.

High-Cost Care Programs: Through our Care Management team, we ensure all members—but especially those with chronic or complex conditions, or those managing multiple health concerns at once— are supported through:

  • Customized outreach
  • Education
  • Assistance with interpreting their benefit package and claims history to identify potential solutions or ways to improve care and reduce costs.

We’ll talk more about this in next week’s blog post.

Chronic Condition Management: Barriers preventing members from achieving their health goals are identified by a team of registered nurses, registered dietitians, behavioral health specialists, and social workers. This team partners with members to provide education and recommend testing and screenings.

Preventive Care Programs: This includes routine checkups, screenings, and immunizations. We offer resources like our Pharmacy Price Check tool, our Find a Doctor tool to ensure a member’s provider is in-network, care management support and a free 24/7 nurse call line for non-urgent health questions. Plus, the Wellframe® app gives members instant access to a dedicated care manager, dietitians, nurses, and other health care professionals who can connect them with health management programs right in the app.

If you have any questions about what goes into premium rates or need help as you’re getting ready for Open Enrollment, please contact your account manager or broker.

Stay tuned next week, where we'll share some available programs that can provide care management support to members with complex conditions and high medical bills.

CenterState CEO

Other Member News

Strategic Communications Media Training
October 30, 2025

New On-Demand Virtual Media Training Now Available

For years, the Strategic Communications Media Training Program has empowered organization leaders, spokespersons, and subject matter expe

NBT Bancorp Inc. Announces Record Third Quarter 2025 Results and Declares Cash Dividend
October 28, 2025

NBT Bancorp Inc. Announces Record Third Quarter 2025 Results and Declares Cash Dividend

NBT Bancorp Inc. (“NBT” or the “Company”) (NASDAQ: NBTB) reported net income and diluted earnings per share for the three and nine months ended Sept.30, 2025.

Warm, hearty meals for casual friendly get-togethers
October 24, 2025

Fulton Dining and Activity Center

Reservations are encouraged, and bussing is available from participants homes to the center.

Image - presenters
October 24, 2025

Join Harris Beach Murtha for a Webinar Covering the Evolving Landscape of the H-1B Visa Program

Attendees will gain practical guidance on compliance strategies, risk mitigation and workforce planning, with a focus on supporting H-1B employees.

2025 Central New York Real Estate Conference
October 21, 2025

2025 Central New York Real Estate Conference

This one-day event offers unparalleled opportunities for networking, lead generation, and brand visibility—whether through attending, tabling, or sponsoring.

October 20, 2025

Springbrook Expands in Central New York with New Syracuse Office

The expansion marks an exciting milestone in Springbrook’s ongoing mission to provide exceptional, person-centered support across the state.

Warm, hearty meals for casual friendly get-togethers
October 17, 2025

Fulton Dining and Activity Center Menu

Reservations are encouraged and bussing is available from participants homes to the center.

Oswego Jiu Jitsu & The Mix Women's Self-Defense Seminar
October 15, 2025

Oswego Jiu Jitsu & The Mix Women's Self-Defense Seminar

Find out more information and register here.

October 15, 2025

Join SUNY Oswego for A Showcase of Innovation, Collaboration and Impact!

RSVP to join us on October 23-24, 2025 at SUNY Oswego for any or all of the following four free events.