Blue Cross and Blue Shield of North Carolina is the only nonprofit health insurer that offers coverage across the state’s 100 counties across all lines of business. That leaves the company with very little room to retreat to more profitable markets when healthcare costs increase.
Tunde Sotunde, MD, who has served as president and CEO since 2020, isn’t shy about what that reality looks like today. The company recorded a net loss of more than $497 million in 2025, following a net income of $68.5 million in 2024 and $133 million in 2023.
“Our system, as it currently exists today, practically is broken,” Dr. Sotunde said on the Becker’s Payer Issues podcast. “It is too damn expensive. It is so complex, fragmented, and inefficient.”
The company’s latest financial results mirror other major losses among BCBS companies over the last year, with many citing rising costs in Medicare Advantage driven by higher utilization, rising hospital inpatient costs, and growing spending on specialty medications, including GLP-1s.
North Carolina is already among the most expensive states in the country for healthcare, according to Dr. Sotunde, pointing to the state’s aging demographics and large rural footprint as compounding factors. Of its 100 counties, 78 are considered rural and 92 are designated as health professional shortage areas, meaning they lack adequate access to primary care and mental health services.
Dr. Sotunde also noted a lack of true price transparency, a fee-for-service reimbursement system that incentivizes volume over value, and fragmented, inefficient healthcare infrastructure among larger issues facing the company.
“The fact that we’re still using fax machines as one of the primary mechanisms of communicating with ourselves across the healthcare ecosystem should tell all of us something,” he said.
Last year, Blue Cross NC restructured under a new nonprofit parent holding company dubbed CuraCor Solutions, which includes a portfolio of health services companies and care delivery assets. The move is designed to allow the insurer to partner and invest in new programs and technologies more quickly, and to better compete with its for-profit, national rivals. Several other BCBS affiliates have pursued similar restructurings in recent years, including Blue Shield of California, Louisiana Blue, Horizon BCBS New Jersey and Blue Cross of Idaho.
Dr. Sotunde is deliberate about the distinction between Blue Cross NC and its multistate competitors. The plan’s pretax earnings target is 4-5% in a strong year, he said, enough to sustain operations and reinvest in its capabilities. What remains goes back to the communities it serves.
“Our shareholders, our stakeholders are the people and communities we serve,” Dr. Sotunde said. “It’s not Wall Street. It is not retail or institutional investors.”
He argued that long-term community presence and mission alignment create competitive advantages that for-profit insurers structurally cannot replicate, noting that the company’s brand trust scores, net promoter scores, and customer satisfaction metrics reached their highest recorded levels in 2025.
One of the more concrete bets the insurer has made is on social determinants of health initiatives. In 2024, the plan launched “Feed Your Health,” which provides eligible members with six months of progressive food support at no cost, ranging from prepared meals and groceries to meal kits and guided shopping, paired with coaching from dietitians and health coaches, and followed by a full year of access to online resources.
The program’s first-year results have shown reductions in both costs and clinical measures. For individual members under 65, inpatient costs decreased $153 per member per month and emergency room visits declined over the 12-month period. Medicare Advantage participants saw medical costs run $227 per member per month lower than non-participants. On the clinical side, participants achieved a 1.5-point reduction in HbA1c within six months, and 86% of MA participants lowered their A1c below 9.0. The share of participants reporting 10 or more unhealthy mental or physical health days also declined through the 12-month period.
“To the extent you can prevent conditions from happening, you can slow down the progression of chronic health conditions and or avoid complications altogether,” Dr. Sotunde said. “Not only is it cheaper in the long run, but you also drive towards better health outcomes and a better overall quality of life.”
Throughout the conversation, he returned to the consistent theme of no single payer, provider, or policymaker being able to solve the cost crisis alone. He described what he called “a coalition of the willing” as the only realistic mechanism for addressing structural flaws across the healthcare system.
“If we’re able to come together and put the consumer, the member, and the patient at the center of healthcare decision making, we will not only be able to drive towards building a better healthcare ecosystem, but also I truly believe that our respective organizations, institutions, and companies will thrive even more so and even exceed our own expectations.”
You can listen to the full conversation with Dr. Sotunde here.
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