As healthcare prices skyrocket, we must work together to bring the costs under control

In an op-ed published by The Boston Globe, BCBSRI President & CEO Martha L. Wofford calls for renewing enhanced federal premium tax credits, describes how soaring healthcare costs are driving up health insurance premiums, and discusses ways Rhode Islanders can work together to improve healthcare affordability, access, and quality.

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Behind the numbers

Healthcare is complicated. These graphics help explain what’s driving up the cost of your care.

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Nearly all of our members’ premiums are spent on healthcare

As a nonprofit health insurer, BCBSRI estimates 87% of premiums will be enough to pay for our members’ healthcare services. In recent years, those costs have been significantly higher than expected, with over 91% of premiums going to pay claims.

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Nearly all of our members’ premiums are spent on healthcare

As a nonprofit health insurer, BCBSRI estimates 87% of premiums will be enough to pay for our members’ healthcare services. In recent years, those costs have been significantly higher than expected, with over 91% of premiums going to pay claims.

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Find out why healthcare costs are rising—and what we can do together to improve access to high-quality, affordable care.

Real solutions for Rhode Islanders

To address this crisis, we must keep working together as a state to balance affordability for Rhode Islanders with stability for our healthcare system. Here's how we're working to improve access to high-quality, affordable care—and how you can help.

BCBSRI has invested $500 million in RI’s primary care practices since 2014 and is also:

  • Increasing fully insured commercial payments to primary care providers (PCPs) by up to 30% by early 2026, as mandated by the Office of the Health Commissioner’s (OHIC’s) recently updated affordability standards
  • Eliminating Rhode Island primary care medical prior authorizations, which will help create additional capacity for more patients to be seen
  • Offering a new provider contract option that provides monthly payments to PCPs to improve financial stability and predictability to support staff hiring and expanded patient access

BCBSRI is offering comprehensive support to our members, including:

  • Providing personalized care navigation assistance to improve member benefit utilization and help empower more informed healthcare decisions through BlueCare Connect, our unique member support solution
  • Launching targeted programs—including for cancer, behavioral health, and kidney disease—to proactively help members improve their health, reduce costly emergency room and hospital visits, and keep care local
  • Encouraging members to access $0 preventive care, including well visits and cancer screenings, to help them stay healthier and find health issues in earlier, more treatable stages

We’re focused on strategies that help members get the medication they need at a cost they can afford, including:

  • Offering improved pricing on high-cost specialty drugs through Synergie Medication Collaborative, a group purchasing organization BCBSRI established in partnership with other Blue Cross Blue Shield (BCBS) companies.
  • Bringing lower cost generic medications directly to consumers through CivicaScript, a nonprofit generic drug manufacturer we formed with other BCBS companies and Civica Rx
  • Shifting to biosimilar and generic medications that offer comparable quality at significantly lower costs

While operating expenses are a small percentage of premiums, every dollar saved helps mitigate premium increases and supports the sustainability of our healthcare system. During the past year, BCBSRI saved $20 million by:

  • Consolidating vendor contracts
  • Deploying technologies for greater efficiency
  • Reducing our workforce with a focus on leadership roles

Improving the affordability of healthcare will take all of us, working together. Here’s how you can help:

  • Stay informed on proposed healthcare legislation and how it could impact you and/or your business
  • Support lower premium growth by opposing legislative/regulatory mandates that would increase healthcare costs
  • Continue to represent your employees’ or constituents’ needs and protect them from premium cost increases that could result from new coverage mandates