Related Items
Using Claims Data to Make a Change
December 1, 2007
Health Care Service Corp. believes the information contained in claims is powerful. The payer, which runs the Blue Cross/Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas, is using claims data to provide medical history summaries to patients and their physicians.
Based on the data, the payer is providing patients with tips on improving their health. And it hopes physicians will use the information to improve quality of care and reduce costs, such as by avoiding ordering redundant tests.
The effort began in 2005 when the payer prepared for Hurricane Rita as it was heading toward the Texas coast. HCSC had witnessed the loss of medical information in the aftermath of Hurricane Katrina and wanted to provide data for more than 800,000 members who were in the projected path of the storm, says Joe Taylor, HCSC's vice president of enterprise business process.
Through its Blue Care Connection program, the Chicago-based payer now is offering its 11.5 million members access to their health information through a Web portal. So far, more than 100,000 members have logged onto the portal, he says.
In phase two, HCSC is rolling out a provider portal that will enable physicians to access the same clinical information about their patients. The payer will use clinical summary technology from MEDecision Inc., Wayne, Pa., for its provider portal.
The provider portal, which will go live by year's end, will be available through Availity LLC, Jacksonville, Fla., and other connectivity partners, Taylor says. The payer decided to go this route because many of its participating providers already are using Availity's other services.
Availity is using its status as a claims clearinghouse to build a portal that could provide physicians with a central access point for claims-based data from multiple payers in a region. The company also is working with Blue Cross Blue Shield of Florida and Humana Inc., Louisville, to bring physicians medical history summaries based on claims.
Taylor hopes physicians will use the clinical summary data to improve the health of their patients. For example, the portal will show a physician whether a patient has had a prescription filled or a test conducted, so the caregiver can follow up.
To ensure the data in the provider and patient portals provides an accurate profile of care, HCSC is encouraging physicians to be as complete as possible when providing diagnosis and procedure codes for claims, Taylor says.
The payer acknowledges that the data in the provider portal is just one of many sources of information a physician will use when treating a patient. But it could prove valuable when a patient is referred to a specialist or in case of an emergency.
Payers, including HCSC, are hoping that providing additional information to physicians will lead to reduced costs because of fewer errors and fewer redundant tests, says John DiStefano, vice president and executive director of the health care payer practice at BearingPoint Inc., McLean, Va. But most payers haven't committed large resources because they don't see the immediate financial benefit, he says.
Although the provider portal has yet to launch, HCSC's patient portal already is using predictive modeling to provide members with alerts, such as pinpointing the lack of a mammogram in a 40-year-old woman's records.
The patient portal also uses clinical rules to examine individual data so members can take preventive measures if they are at risk for certain conditions. For instance, if a patient is overweight and there is a history of diabetes in the family, the payer can recommend a nutritionist or exercise plan. The portal also offers the member educational materials.
HCSC nurses are monitoring data in the patient portal and interacting with members who are either at risk of chronic conditions or already suffering from one, Taylor says. The nurses offer suggestions on modifying behavior and lifestyle.
Since launching the patient portal, HCSC has noticed that more patients are taking the appropriate disease management steps. For example, more diabetics are having the necessary tests performed regularly, Taylor says. But financial benefits have been difficult to measure, he says. The goal of the portal is to prevent adverse events from happening, which isn't easy to measure. "If you're looking at this expecting to have an immediate financial impact it probably won't make sense," Taylor says. "You have to do it because it's the right thing to do for the health of the members, and in the long term, you will save money."
Consumer Health Archive
Electronic Health Records Archive
Payers Archive
I.T. Spotlights
- About Us
- Advertising/Media Kit
- Reprints
- Editorial Calendar
- Contact Us
- Customer Service
- Privacy Statement
©2008 HealthDataManagement and SourceMedia, Inc. All rights reserved.
SourceMedia is an Investcorp company.
Use, duplication, or sale of this service, or data contained herein, is strictly prohibited.
