It is going to take all of us. Today!

This op-ed was written by Jeff Russell, president and CEO of Blue Cross and Blue Shield of Nebraska.

Recently, I outlined the serious issues facing the U.S. health care system and the urgent need for all stakeholders — insurance companies, health care providers, employers, consumers and policymakers — to collaborate on meaningful solutions. I truly believe that by working together for the greater good, we can create a stronger, more effective health care system. In fact, one of the reasons I joined Blue Cross and Blue Shield of Nebraska is that I believe we can be a catalyst for meaningful change in our state.

But one entity can’t move a mountain alone. To solve a problem that impacts nearly everyone in our state, all stakeholders must come to the table and get actively engaged.

Here are the key focus areas I believe can make the most difference:

Technology

The health care ecosystem must introduce and use technology in a much larger way. Today — in 2025! — Blue Cross and Blue Shield of Nebraska still receives patient medical information and forms from providers via fax. In fact, we receive and send more than 400,000 pages of faxes every month. Imagine a world where you want to buy something from Amazon, but instead of a quick click of a button, you had to fax them and then wait for their response — which would also be via fax. That is how broken and inefficient our health care system is today.

What is needed is a real-time, transparent digital health record that is accessible with appropriate permission by patients, providers and payers and isn’t tied to any one system. It needs to be accessible at the point of care and include not only clinical data but also important cost information. This would reduce time, redundancy and the potential for errors exponentially, which in turn would impact not only the overall cost of health care, but the quality of care as well.

Policy makers, employers and health care systems: Consider this an invitation to join us in making this a reality.

Collaboration and compromise

Without an open-minded spirit of collaboration and compromise, meaningful change is impossible. An antagonistic “us vs them” attitude between any of the health care system’s stakeholders is not only unproductive—it is counterproductive. Our unified goal must be to streamline the system processes that are contributing to costly administrative inefficiencies under the current fee-for-service model. All sides of the health care system equation (us included) must do better. We are committed to coming to the table willing to hear all perspectives.

This year, we are already seeing the benefits of this kind of collaboration. During this year’s Unicameral session, for example, we were proud to partner with the Nebraska Hospital Association and Nebraska Medical Association on LB 77, which resulted in the Ensuring Transparency in Prior Authorization Act. This will improve the prior authorization process in our state by reducing the number of services subject to prior authorization, creating a standardized request form and ensuring continuity of care when patients change health plans. We will continue to work on more ways to streamline processes and improve how we work with our provider partners on behalf of our members. We need providers to reciprocate by leveraging technology not to add codes to medical bills but to improve care and coordination.

Preventive care

Consumers have an important role to play as well. One of the most powerful tools for improving patient health outcomes and reducing costs is also one of the most underutilized: preventive care. From annual comprehensive exams to routine screenings, preventive services are designed to catch health issues early — or stop them before they start. Yet millions of Americans still go without them, and the consequences are costly. Here are some sobering statistics:

• In 2015, only 8.5% of adults aged 35 and older received all recommended high-priority preventive services. By 2020, that number dropped to 5.3%, showing a concerning trend.¹
• Only 50% of Blue Cross and Blue Shield of Nebraska members got any preventive exam in 2024, even though all of our plans cover these services, most at no cost to the patient.²
• Mental health conditions and chronic diseases like heart disease, diabetes, and cancer account for nearly 90% of the nation’s nearly $5 trillion in annual health care spending.³  When lost productivity is included, the total economic impact of chronic disease reaches $3.7 trillion, nearly one-fifth of the U.S. economy.⁴

But this can change. From my previous experience in the dental insurance industry, I know how powerful and lasting an impact preventive care can have.

Incredibly, prior to World War I, only about 7% of American households had a toothbrush. Needless to say, during WWI, American military authorities considered dental disease a national crisis because of the extremely poor oral health of many recruits.⁵ Things changed in the 1960s when fluoride became available in the water, patients believed they needed to see their dentist on an annual basis for a cleaning and exam, and dental insurance covered the costs of this annual visit. Today, the oral health of Americans is dramatically improved over what it was just a generation ago.

We have the opportunity in the medical world to make that same kind of shift. As I mentioned, all Blue Cross and Blue Shield of Nebraska plans cover preventive exams and screenings, the majority at no cost to the member. We are also introducing a new program in 2026 which provides members with two free customized health profiles each year, to educate them on their current and future health risks and the steps they can take to better manage their health.

Some have said that this is just another cycle of increasing health care expenses. I disagree. We are facing a moment of truth about the U.S. health care system and it requires all of us to take immediate action. We can — and should — be the architects of the kind of change that will keep our health care system sustainable in the years to come. We call on other stakeholders to join with us to make Nebraska a leader in this critical work. Who is willing to join us?

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¹ “Use of Clinical Preventive Services in the United States.” Agency for Healthcare Research and Quality. (2019). https://www.ahrq.gov/data/infographics/us-clinical-preventive-services.html

² According to Blue Cross and Blue Shield of Nebraska data.

³ CDC’s Fast Facts: Health and Economic Costs of Chronic Conditions page.

⁴ Waters, H., & Graf, M. (2018). The costs of chronic disease in the U.S. Milken Institute. Retrieved from https://milkeninstitute.org/content-hub/research-and-reports/reports/costs-chronic-disease-us

⁵ Wynbrandt, James. The Excruciating History of Dentistry: Toothsome Tales & Oral Oddities from Babylon to Braces. St. Martin’s Griffin, 2000.