Making the Health Care System Work Better Together

Aug. 08, 2017

Where Data Flows, Improvements are Bound to Follow

Payers and providers are increasingly collaborating to share clinical and claims data, with the shared goal of working to improve health outcomes and better manage the overall cost of care to consumers.

One of the main goals of Blue Cross and Blue Shield of Montana (BCBSMT) is to help our members, your patients, have access to quality, affordable health care. Access to data and analytics in a way that helps transforms data into actionable insights plays a role in meeting this goal and helps drive value-based outcomes. Secure and timely information exchange across health system stakeholders, without regard to geography, point of care or type of information system used, helps enable better care connections and more informed diagnostic and treatment decisions.

BCBSMT has launched a multi-pronged, multi-year effort to put quality, provider performance and members' clinical data within easy reach of providers, electronically, 24/7. Our endeavors are bringing technology experts, data scientists, health care quality professionals and select participating providers together to create and fine-tune new and sophisticated tools and systems.

Three Synergistic Data Solutions to Help Improve Quality of Care

  1. We are now in the pilot stage of offering new, strategic reporting of providers' own practice data, called Provider and Network Decision Analytics(sm). This tool will provide a more comprehensive evaluation of providers' cost efficiency performance and treatment pattern differences compared to their peers within the network of independently contracted providers, using claims data from our members. We are currently evaluating the process and look to make adjustments before we deliver this insightful reporting in the near future. One goal of the tools is help you and other providers collectively learn from each other, leveraging each other's individual strengths while gaining new insights into successful practices of others to help drive improvements in care delivery.

    This tool will enable you to:

    • View how your relative cost performance derived from episodes of care, such as treatments for appendicitis or osteoarthritis, compares to the performance of similar providers in your area
    • See additional reporting to demonstrate provider-to-provider relationships through shared patient analysis (SPA) as teams of providers naturally form working relationships
    • Understand how care given by providers you share patients with as a team affects the total cost of care for your patients
    • Compare how services you provide your patients varies from some of your peers and how those peers may treat patients with similar conditions
    • Identify actions you can take that may have a positive impact on your patients' health and help reduce their out of pocket costs
  2. We believe access to this type of data can drive both care value and quality enhancements.

  1. For quality measurement and reporting, we are introducing Electronic Quality Intelligence for Providers(sm).  Our new care quality reporting tool is designed to help enable providers to view their quality performance against various standardized performance measures across their entire BCBSMT patient population. It seeks to deliver timely information to providers about patient care and risk gaps. Quality performance can be viewed at various levels: by organization, plan type and individual provider. Filters that are envisioned for this program will enable providers to view their quality performance by medical condition, patient gender and/or age range, or individual patient. These reports are meant to:
    • Enable providers to better monitor their quality performance and attend to potential gaps in care more quickly
    • Support the development of scalable quality improvement programs that are more responsive to priority quality performance trends
    • Better inform care teams and practice leadership decision making

  2. This project is currently being reviewed with a select audience. The new tool is being rolled out in waves, with a broader implementation planned for in the near future with future plans to add physician specialist reporting. Ultimately, it will also be offered to facilities to aid in their accreditation and quality reporting requirements.

  1. Our Clinical Data Exchange solution creates a bi-directional flow of information between BCBSMT and the independently contracted participating providers. We are advancing a series of services to exchange clinical information electronically 24/7. Special focus has been placed on developing secure data exchange capabilities that are readily accessible for providers and easily incorporated within their existing workflows.

    This effort builds channels and capabilities to enhance the exchange of key categories of clinical data that providers and BCBSMT rely on to make more informed decisions and better manage operations. Our data exchange solution will make it easier and quicker for providers to access members' health summary data at the site of care and submit what BCBSMT needs for health plan operations such as claims processing, precertification reviews, health care management, risk adjustment applications, and quality improvement initiatives.

    BCBSMT anticipates introducing its clinical data solution in the months ahead.
    BCBSOK is in the early stages of implementing its statewide clinical data exchange solution.

We are committed to becoming your payer of choice by making it easier to do business with us. We know that we can work together to enhance the care our members receive and help them better afford the care they need. Together, we can make the health system work better for all stakeholders.

Keep reading future issues of the Blue Review to find out what's new.

The initiatives discussed in this article rely upon claims information that BCBSMT receives from providers and therefore, may not represent a complete picture of a provider's practice or the medical services that a member may have received. The initiatives are designed with the goal to assist health care providers and members in better coordinating care and improving health outcomes.  The programs are not a substitute for the independent medical judgment of a health care provider. Health care providers are instructed to use their own best medical judgment based upon all available information and the condition of the patient in determining a course of treatment.