Empower Consumers and Providers

Blue Cross and Blue Shield of Alabama

Pediatric Weight Management Tool Kit for Health Professionals Childhood Obesity Prevention

Blue Cross and Blue Shield of Alabama’s Pediatric Weight Management Tool Kit for Health Professionals combines recommendations from the Expert Committee on the Assessment, Prevention and Treatment of Childhood and Adolescent Overweight and Obesity with useful Body Mass Index assessment tools, reference laboratory indicators and communication strategies. The Plan’s goal in developing this reference is to provide health professionals with the tools they need to address the public health issue of childhood obesity. To receive the tool kit, providers simply send an e-mail request to (JavaScript must be enabled to view this email address).

Rx Benefit Manager

Blue Cross and Blue Shield of Alabama provides members of its pharmacy plan with access to the Rx Benefit Manager, an online tool offering detailed prescription histories, drug price comparisons, special alerts for multi-source brand drugs, group-specific benefit summary data and drug and pharmacy look-up features. The tool is available through the secure myBlueCross website and allows the Plan to communicate directly with members regarding formulary changes, medication refills and drug alerts.

Premera Blue Cross Blue Shield of Alaska

Go2dental Dental Decision Support Tools

Through a partnership with Go2dental.com, Premera Blue Cross Blue Shield of Alaska provides members with a Web-based suite of tools designed to help them make informed decisions about their oral health and dental expenses. Among them:

Dental Cost Estimator – Provides estimates of expenses for various dental services, from routine checkups to major procedures
Ask a Dentist – Enables members to gain a better understanding of their treatment options
Dental Risk Assessment – Allows members to complete an online survey gauging their oral health and recommending further consultation if necessary

This website also powers the Plan’s national dental directory search engine.

HRA- and HSA-Paired Health Plans

Premera Blue Cross Blue Shield of Alaska offers a number of high-deductible health plans for individuals and employers that can be paired with health reimbursement arrangements (HRAs) or health savings accounts (HSAs). HRAs give employers greater flexibility and control in designing benefit packages and offer employees the convenience of integrating claims processing with the HRA funds made available through their employer. Premera’s benefit packages are designed with high-value medical and prescription pharmacy services including no or minimal out-of-pocket costs. This positions Premera’s plans so members can focus on health and wellness through their benefit plan design without cost share barriers. Premera’s qualified high-deductible health plans focus this high-value design on robust preventive medical and prescription pharmacy coverage meeting HSA qualifications. This ensures that Plan members have well-tailored health coverage to combine with a fully portable, tax-advantaged HSA.

My Rx Choices

Premera Blue Cross Blue Shield of Alaska launched the Web-based My Rx Choices program to increase member participation in prescription benefit plans and equip them to make informed healthcare decisions. The tool provides data on the medications they currently take – including the annual cost of those therapies – and reveals the price of lower-cost alternatives that are available for their condition. My Rx Choices also integrates the results of Consumer Reports’ Best Buy Drugs, allowing members to review independently validated information on medications’ safety, effectiveness and price.

One Health Port Medication Information Exchange Project

Premera Blue Cross Blue Shield of Alaska collaborated with Rx Hub and One Health Port to enable providers to access patients’ medication histories, pharmacy benefits and drug formulary through a secure online portal accessible via an electronic medical record, e-prescribing tool or hospital information system. In addition to creating efficiencies in physician practices, real-time access to patients’ medication histories helps stem medication errors, reduce harmful drug interactions and improve care coordination.

Point-of-Sale Prior Authorization Edit Program

Premera Blue Cross Blue Shield of Alaska’s Point-of-Sale Prior Authorization Edit Program promotes appropriate medication use by reviewing prescriptions when they are ordered at pharmacies and determining if the request aligns with recommended guidelines. If the prescription therapy is within recommended guidelines, it is filled without interruption. Prescriptions flagged for failing to meet guidelines are referred back to the physician for further consultation, helping ensure that members receive safe, high-quality care. The program has improved care coordination and fostered collaboration among members, pharmacists and providers.

Specialty Pharmacy Member Clinical Support

Premera Blue Cross Blue Shield of Alaska developed the specialty pharmacy program to provide support for drug handling, self-administration of medications, disease state counseling and adverse reaction management. The program aims to reduce the costs of specialty drugs for conditions such as multiple sclerosis, rheumatoid arthritis and hepatitis C, as well as ease administrative burden and promote high-quality care for members. Staffed by pharmacists, nurses and patient care representatives, specialty pharmacies meet the unique needs of people taking specialty drugs by offering clinical support and counseling to ensure members are administering their prescriptions properly and following their physicians’ recommendations. Specialty pharmacies also coordinate directly with Premera on benefit advisories.

Blue Cross and Blue Shield of Arizona

Arizona Health-e Connection

Blue Cross Blue Shield of Arizona is playing a leadership role in the Arizona Health-e Connection, an organization working to create a statewide health information exchange (HIE) and encourage health information technology (HIT) adoption. Recognizing that HIE and HIT can help improve quality and reduce costs, the Arizona Health-e Connection is currently:

Serving as an information clearinghouse and providing education and outreach;
Promoting the adoption and implementation of interoperability standards;
Acting as the rule-setting body for advancing HIT; and
Assisting with health information infrastructure support and development.

Telemedicine for Teletrauma Program

Blue Cross Blue Shield of Arizona supports a University Medical Center (UMC) program designed to address the shortage of trauma specialists in rural hospitals through the innovative application of health information technology. Using a closed-circuit system with videoconferencing and remote monitoring equipment, trauma specialists at UMC guide care for injured patients at rural facilities, speeding care delivery and helping save lives.

Arkansas Blue Cross and Blue Shield

Advanced Health Information Network

To seamlessly integrate care delivery, claims processing and transaction systems, Arkansas Blue Cross and Blue Shield developed the Advanced Health Information Network (AHIN) in collaboration with a number of healthcare systems across the state. The network provides a secure, online system with advanced functionality, enabling physicians and hospitals to boost efficiency through real-time access to eligibility, claims and claim-status information.

Blue-by-Design

Arkansas Blue Cross and Blue Shield offers Blue-by-Design coverage solutions, a suite of consumer-directed products for small and large employers that can be customized based on coverage options and deductible levels. These affordable plans are coupled with health savings accounts (HSAs) or health reimbursement arrangements (HRAs) to provide employees with greater control over their personal medical expenses. Additionally, Blue-by-Design products offer an array of tools and resources to empower consumers in their healthcare decisions, including cost and quality guides, access to health coaches and an index of online health information.

Personal Health Record

Arkansas Blue Cross and Blue Shield provides each member with a personal health record (PHR) in order to improve care coordination across the healthcare spectrum. As the largest insurer in Arkansas, the Plan offers PHRs to one-third of the state’s residents and allows members to keep their records even if they are no longer covered by Arkansas Blue Cross and Blue Shield. Each member’s PHR is auto-populated with a summary of medical claims submitted during Plan enrollment. Individuals can also enter personal, non-claims information into their PHR, which is maintained on a secure network accessible only to their physician and other healthcare providers.

Anthem Blue Cross

American Imaging Management, Inc.™

American Imaging Management (AIM™) – a subsidiary of Anthem Blue Cross’s parent company – promotes the appropriate use of imaging technology and radiation safety. Imaging service quality is advanced by developing and deploying programs to help improve appropriateness of outpatient advanced imaging through the application of evidence-based clinical guidelines. As part of its commitment to providing physicians and members with information to support informed treatment decision-making, AIM’s Patient Safety website offers information on the radiation dosage associated with these advanced imaging modalities. Its interactive human model allows users to select a specific imaging modality/exam and provides the most up-to-date estimated radiation dosage for that modality/exam.

Anthem Care Comparison

Anthem Care Comparison provides transparent quality and cost information for 39 common medical procedures and services, including hip and knee replacements, gall bladder removal and pediatric/primary care physician office visits. The tool displays total costs for an episode of care using actual hospital, physician and ancillary service costs and includes information on various quality factors such as number of services performed, the number of patients with complications or infections and the availability of an onsite ICU. Bundling the costs by episode of care helps members understand the overall cost of treatment, not just specific à la carte physician and hospital services. By allowing members to assign their own level of importance to each available quality factor, Anthem Care Comparison generates a personalized, prioritized list of hospitals matching the member’s own quality preferences.

Health Management Corporation®

Health Management Corporation (HMC) – a subsidiary of Anthem Blue Cross and Blue Shield’s parent company – takes a proactive approach to personalized health coaching that results in healthier and happier people, less missed work and fewer hospital stays. Its integrated technology helps ensure increased compliance with health guidelines. HMC nurse care managers, physicians, pharmacists, dietitians, exercise physiologists and other healthcare professionals help members navigate the complexity of accessing healthcare – from the most difficult, costly and debilitating medical conditions that increase healthcare costs to the wellness programs that help prevent them. In the process, strong relationships form and positive health outcomes are realized. HMC is taking healthcare to a higher level by helping members improve and maintain the health and wellness with a comprehensive suite of health and wellness, disease management and lifestyle management solutions. From prevention and wellness through advanced care management, HMC provides information and guidance on chronic conditions and healthy lifestyles to increase members’ awareness and motivation and help reduce costs for everyone.

MyHealth@Anthem®

Clinical quality and safety support is available to Anthem Blue Cross members through MyHealth@Anthem, an online personal health record (PHR) powered by WebMD that converts medical claims into a longitudinal PHR and also includes drug and laboratory information that members can share with physicians. Members can access their up-to-date health information and receive clinical alerts for drug safety and care options. Members can also learn more about planned or contemplated surgery through the online surgical procedure guide, which includes animated video depictions of surgery. Specific content includes:

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

PrecisionRx Specialty Solutions – a subsidiary of Anthem Blue Cross’s parent company – strives for 100 percent guideline adherence, and its new state-of-the-art medication distribution center in Indianapolis helps ensure optimal dosages and medication safety. Care coordinators work directly with members to schedule timely delivery of medications; educate and monitor drug regimens for diseases such as hepatitis B, hemophilia, rheumatoid arthritis and cancer; and encourage therapy adherence. Clinical pharmacists evaluate diagnoses to determine the appropriate therapy, review prescriptions for accuracy and safety and provide individualized counseling, while registered nurses track the progress of treatment and develop goals for managing potential side effects.

Resolution Health™, Inc.

Resolution Health, Inc. (RHI™) – a subsidiary of Anthem Blue Cross's parent company – provides actionable information to consumers through clinical messaging technology. RHI integrates and analyzes medical and laboratory claims data through an evidence-based rules engine. The output of this analysis generates clear, actionable clinical alerts or messages regarding health improvement, patient safety and member cost-saving opportunities. These clinical messages for optimal care are developed by faculty at Harvard Medical School. There are member and physician messages currently deployed that identify gaps in care that a member is receiving, including whether a medication or laboratory test is required for a specific clinical condition, a member is not being adherent to a therapy prescribed or preventive clinical guidelines such as cancer screening are not being followed.

Subimo™ Hospital Comparison Tool

The Subimo Hospital Comparison tool allows Anthem Blue Cross members to select two or more hospitals to compare side by side so they can look at the hospitals’ experience with specific medical conditions or procedures. The tool delivers comparative information in three categories: quality and experience; reputation; and characteristics such as whether the institution is a teaching hospital, performs many high-tech procedures and/or has an onsite ICU. By allowing members to assign their own level of importance to each available quality factor, the Subimo Hospital Comparison tool generates a personalized, prioritized list of hospitals matching the member’s own quality preferences. Subimo is the trademark of WebMD Health Services Group, Inc.

Zagat Health Survey

With the Zagat Health Survey, Anthem Blue Cross members are able to access peer-to-peer interactions among healthcare consumers, data and tools necessary to help them take a more active role in their healthcare decision-making. Consumer experience information such as that enabled by the Zagat Health Survey tool is an important complement to the clinical quality, cost and other tools that the Plan provides to support consumers’ health care decision-making. The survey tool helps enable members to review and evaluate physicians based on a set of distinct criteria, creating a trusted resource to support informed member decision-making. The online survey tool allows consumers to review their doctor visits based on:

Trust
Communication
Availability
Environment

In addition, the survey will feature a comments section, allowing members to expand on their ratings. The survey and results are free of charge to members via the Plan’s website.

Blue Shield of California

There are currently no plans in this category.

Anthem Blue Cross and Blue Shield (Colorado)

American Imaging Management, Inc.™

American Imaging Management (AIM™) – a subsidiary of Anthem Blue Cross and Blue Shield’s parent company – promotes the appropriate use of imaging technology and radiation safety. Imaging service quality is advanced by developing and deploying programs to help improve appropriateness of outpatient advanced imaging through the application of evidence-based clinical guidelines. As part of its commitment to providing physicians and members with information to support informed treatment decision-making, AIM’s Patient Safety website offers information on the radiation dosage associated with these advanced imaging modalities. Its interactive human model allows users to select a specific imaging modality/exam and provides the most up-to-date estimated radiation dosage for that modality/exam.

Anthem Care Comparison

Health Management Corporation®

MyHealth@Anthem®

Clinical quality and safety support is available to Anthem Blue Cross and Blue Shield members through MyHealth@Anthem, an online personal health record (PHR) powered by WebMD that converts medical claims into a longitudinal PHR and also includes drug and laboratory information that members can share with physicians. Members can access their up-to-date health information and receive clinical alerts for drug safety and care options. Members can also learn more about planned or contemplated surgery through the online surgical procedure guide, which includes animated video depictions of surgery. Specific content includes:

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

PrecisionRx Specialty Solutions – a subsidiary of Anthem Blue Cross and Blue Shield’s parent company – strives for 100 percent guideline adherence, and its new state-of-the-art medication distribution center in Indianapolis helps ensure optimal dosages and medication safety. Care coordinators work directly with members to schedule timely delivery of medications; educate and monitor drug regimens for diseases such as hepatitis B, hemophilia, rheumatoid arthritis and cancer; and encourage therapy adherence. Clinical pharmacists evaluate diagnoses to determine the appropriate therapy, review prescriptions for accuracy and safety and provide individualized counseling, while registered nurses track the progress of treatment and develop goals for managing potential side effects.

Resolution Health™, Inc.

Resolution Health, Inc. (RHI™) – a subsidiary of Anthem Blue Cross and Blue Shield’s parent company – provides actionable information to consumers through clinical messaging technology. RHI integrates and analyzes medical and laboratory claims data through an evidence-based rules engine. The output of this analysis generates clear, actionable clinical alerts or messages regarding health improvement, patient safety and member cost-saving opportunities. These clinical messages for optimal care are developed by faculty at Harvard Medical School. There are member and physician messages currently deployed that identify gaps in care that a member is receiving, including whether a medication or laboratory test is required for a specific clinical condition, a member is not being adherent to a therapy prescribed or preventive clinical guidelines such as cancer screening are not being followed.

Subimo™ Hospital Comparison Tool

The Subimo Hospital Comparison tool allows Anthem Blue Cross and Blue Shield members to select two or more hospitals to compare side by side so they can look at the hospitals’ experience with specific medical conditions or procedures. The tool delivers comparative information in three categories: quality and experience; reputation; and characteristics such as whether the institution is a teaching hospital, performs many high-tech procedures and/or has an onsite ICU. By allowing members to assign their own level of importance to each available quality factor, the Subimo Hospital Comparison tool generates a personalized, prioritized list of hospitals matching the member’s own quality preferences. Subimo is the trademark of WebMD Health Services Group, Inc.

Anthem Blue Cross and Blue Shield (Connecticut)

American Imaging Management, Inc.™

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Zagat Health Survey

With the Zagat Health Survey, Anthem Blue Cross and Blue Shield members are able to access peer-to-peer interactions among healthcare consumers, data and tools necessary to help them take a more active role in their healthcare decision-making. Consumer experience information such as that enabled by the Zagat Health Survey tool is an important complement to the clinical quality, cost and other tools that the Plan provides to support consumers’ health care decision-making. The survey tool helps enable members to review and evaluate physicians based on a set of distinct criteria, creating a trusted resource to support informed member decision-making. The online survey tool allows consumers to review their doctor visits based on:

Trust
Communication
Availability
Environment

In addition, the survey will feature a comments section, allowing members to expand on their ratings. The survey and results are free of charge to members via the Plan’s website.

Blue Cross Blue Shield of Delaware

BCBSD Quality Improvement Program

Blue Cross Blue Shield of Delaware performs an extensive review of quality practices each year to allow consumers to reliably compare the performance of different managed healthcare platforms. Standards of care, such as the effectiveness of specific health practices like immunizations, postpartum check-ups and the use of antidepressants, are judged according to Healthcare Effectiveness Data and Information Set (HEDIS) measures. The Consumer Assessment of Health Plans Survey (CAHPS) serves to measure the performance of BCBSD’s customer service, claims processing and health plan rating, as well.

Through HEDIS and CAHPS reviews, BCBSD receives accreditation from the National Committee for Quality Assurance (NCQA), ensuring Plan members are provided with safe, effective care and service of the highest quality.

E-Prescribe Program

Blue Cross Blue Shield of Delaware partnered with DrFirst in 2006 to provide 250 network physicians with PDAs and e-prescribing software to electronically transmit prescriptions. Using a series of recruitment mailings, training sessions and informational materials about the benefits of e-prescribing, BCBSD has been able to raise awareness about the value of health information technology to improve quality, safety and cost-savings.

Through the use of the e-prescribing system, physicians are able to access real-time information on a patient’s medical history, including active medications, allergy information and past diagnoses, as well as receive alerts of potential adverse drug events when ordering a new prescription. Additionally, the e-prescribing service offers generic drug alternatives to brand name prescriptions that present significant cost-saving options to members.

Personal HealthKey Pilot Program

Blue Cross Blue Shield of Delaware launched the Personal HealthKey pilot program to explore the effectiveness of using portable personal health records (PHR) stored on USB flash-drive technology to track and manage members’ health and wellness information. Participating members are provided with USB flash-drives containing their personal health information and will be asked to participate in three surveys over a 12-month period to gauge the utilization and impact of the devices. The pilot will identify opportunities to provide members with useful information that may improve their overall health, as well as determine the effectiveness of the personal health key to enhance health awareness and care coordination.

Blue Cross and Blue Shield of Florida

Availity Care Profile

Blue Cross and Blue Shield of Florida played a key role in the statewide deployment of the Availity Care Profile (ACP), the nation’s first multiple-payer electronic health record. Using claims-based information, the ACP provides a consolidated view of patients’ healthcare services across physicians and providers, helping improve patient safety, eliminate duplicate procedures and reduce fraud. Furthermore, the ACP facilitates health information exchange and systems interoperability among clinicians and payers, yielding new efficiencies and cost savings. For example, a study by Point-of-Care Partners, a consortium of independent health IT consultants, found that the ACP led to a time savings of three to six minutes on patient assessments during a pilot period, leading to more productive and efficient encounters with commensurate cost savings. Approximately 400 Tampa Bay-area provider sites now have access to the ACP, and the capability is expanding to other Florida geographies, including Gainesville, Jacksonville, Miami and Tallahassee.

e-Visits with RelayHealth

Using the RelayHealth system, Blue Cross and Blue Shield of Florida allows patients to receive and physicians to be reimbursed for non-emergency and follow-up care provided through online consultations. In addition to reducing the need for office visits, the Web-based consultations are archived to ensure accurate documentation and care continuity. Members can also use the system for a variety of other purposes, including scheduling appointments, receiving normal lab results and requesting prescription renewals or refills.

ePrescribe Florida

Blue Cross and Blue Shield of Florida is working to spearhead ePrescribe Florida, a collaborative of Florida’s leading health plans and provider organizations that aims to make Florida the nation’s leader in e-prescribing adoption. Specifically, the program promotes the use of e-prescribing tools that allow providers to send point-of-service prescriptions directly to pharmacies, with instant access to patient histories and potential medication interactions. Noting low provider adoption of the technology to date, ePrescribe Florida conducts outreach efforts that focus on retail pharmacy chains, other state and regional health plans, core technology vendors and other industry stakeholders. The program also creates a forum that encourages proactive dialogue on e-prescribing’s benefits and helps providers understand and leverage industry best practices.

Health IT Initiatives

Blue Cross and Blue Shield of Florida (BCBSF) has launched several health IT initiatives designed to strengthen care quality and reduce healthcare costs. Among them:

Availity Care Profile – A payer-based electronic health record that provides one-stop, interoperable access to patients’ consolidated health record
CareCalc – A tool that enables physician office staff to calculate the patient’s financial responsibility at any time during the service
RelayHealth – An online communication tool that offers a safe and confidential way for patients and physicians to consult about non-urgent healthcare needs
Epocrates – A drug reference tool that offers free mobile and Web-based access to BCBSF formularies

The Plan also participates in ePrescribe Florida, an initiative that includes the state’s leading health plans, physician and provider associations, pharmacy retail chains and associations, quality improvement organizations, infrastructure and application vendors and other key industry and government stakeholders. To learn more about BCBSF’s health IT initiatives, please visit the Plan’s website.

HSA/High-Deductible Health Plans and HRA-Based Health Plans

Blue Cross and Blue Shield of Florida offers Health Reimbursement Account (HRA)-based plans for fully insured and self-funded groups and high-deductible health plans with Health Savings Accounts (HSAs) for groups and individuals. HRA-based plans help members manage their healthcare costs in a way that they control, using the HRA that their employer establishes to reimburse them for qualified medical expenses such as deductibles, copayments and prescription drug costs. High-deductible BlueOptions plans paired with HSAs, meanwhile, can yield lower insurance premiums while enabling members to glean tax savings and access money for health-related expenses now and in the future.

Member Health Statement

Blue Cross and Blue Shield of Florida (BCBSF) recently introduced its Member Health Statement, an easy-to-read, visually appealing document that provides relevant claims data such as balance, deductible and status information. The new Member Health Statement is a cornerstone of the Plan’s retail strategy. In addition to helping members understand their benefits, the statement provides a new communication channel between BCBSF and its members; for example, the Plan can use the Member Health Statement as an avenue for educating members on affordable product options, wellness programs and strategies for becoming informed healthcare consumers.

Blue Cross and Blue Shield of Georgia

American Imaging Management, Inc.™

American Imaging Management (AIM™) – a subsidiary of Blue Cross and Blue Shield of Georgia’s parent company – promotes the appropriate use of imaging technology and radiation safety. Imaging service quality is advanced by developing and deploying programs to help improve appropriateness of outpatient advanced imaging through the application of evidence-based clinical guidelines. As part of its commitment to providing physicians and members with information to support informed treatment decision-making, AIM’s Patient Safety website offers information on the radiation dosage associated with these advanced imaging modalities. Its interactive human model allows users to select a specific imaging modality/exam and provides the most up-to-date estimated radiation dosage for that modality/exam.

Anthem Care Comparison

Blue Cross and Blue Shield of Georgia members have access to Anthem Care Comparison, which provides transparent quality and cost information for 39 common medical procedures and services, including hip and knee replacements, gall bladder removal and pediatric/primary care physician office visits. The tool displays total costs for an episode of care using actual hospital, physician and ancillary service costs and includes information on various quality factors such as number of services performed, the number of patients with complications or infections and the availability of an onsite ICU. Bundling the costs by episode of care helps members understand the overall cost of treatment, not just specific à la carte physician and hospital services. By allowing members to assign their own level of importance to each available quality factor, Anthem Care Comparison generates a personalized, prioritized list of hospitals matching the member’s own quality preferences.

Health Management Corporation®

Health Management Corporation (HMC) – a subsidiary of Blue Cross and Blue Shield of Georgia’s parent company – takes a proactive approach to personalized health coaching that results in healthier and happier people, less missed work and fewer hospital stays. Its integrated technology helps ensure increased compliance with health guidelines. HMC nurse care managers, physicians, pharmacists, dietitians, exercise physiologists and other healthcare professionals help members navigate the complexity of accessing healthcare – from the most difficult, costly and debilitating medical conditions that increase healthcare costs to the wellness programs that help prevent them. In the process, strong relationships form and positive health outcomes are realized. HMC is taking healthcare to a higher level by helping members improve and maintain the health and wellness with a comprehensive suite of health and wellness, disease management and lifestyle management solutions. From prevention and wellness through advanced care management, HMC provides information and guidance on chronic conditions and healthy lifestyles to increase members’ awareness and motivation and help reduce costs for everyone.

MyHealth@Anthem®

Clinical quality and safety support is available to Blue Cross and Blue Shield of Georgia members through MyHealth@Anthem, an online personal health record (PHR) powered by WebMD that converts medical claims into a longitudinal PHR and also includes drug and laboratory information that members can share with physicians. Members can access their up-to-date health information and receive clinical alerts for drug safety and care options. Members can also learn more about planned or contemplated surgery through the online surgical procedure guide, which includes animated video depictions of surgery. Specific content includes:

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

PrecisionRx Specialty Solutions – a subsidiary of Blue Cross and Blue Shield of Georgia’s parent company – strives for 100 percent guideline adherence, and its new state-of-the-art medication distribution center in Indianapolis helps ensure optimal dosages and medication safety. Care coordinators work directly with members to schedule timely delivery of medications; educate and monitor drug regimens for diseases such as hepatitis B, hemophilia, rheumatoid arthritis and cancer; and encourage therapy adherence. Clinical pharmacists evaluate diagnoses to determine the appropriate therapy, review prescriptions for accuracy and safety and provide individualized counseling, while registered nurses track the progress of treatment and develop goals for managing potential side effects.

Resolution Health™, Inc.

Resolution Health, Inc. (RHI™) – a subsidiary of Blue Cross and Blue Shield of Georgia’s parent company – provides actionable information to consumers through clinical messaging technology. RHI integrates and analyzes medical and laboratory claims data through an evidence-based rules engine. The output of this analysis generates clear, actionable clinical alerts or messages regarding health improvement, patient safety and member cost-saving opportunities. These clinical messages for optimal care are developed by faculty at Harvard Medical School. There are member and physician messages currently deployed that identify gaps in care that a member is receiving, including whether a medication or laboratory test is required for a specific clinical condition, a member is not being adherent to a therapy prescribed or preventive clinical guidelines such as cancer screening are not being followed.

Subimo™ Hospital Comparison Tool

The Subimo Hospital Comparison tool allows Blue Cross and Blue Shield of Georgia members to select two or more hospitals to compare side by side so they can look at the hospitals’ experience with specific medical conditions or procedures. The tool delivers comparative information in three categories: quality and experience; reputation; and characteristics such as whether the institution is a teaching hospital, performs many high-tech procedures and/or has an onsite ICU. By allowing members to assign their own level of importance to each available quality factor, the Subimo Hospital Comparison tool generates a personalized, prioritized list of hospitals matching the member’s own quality preferences. Subimo is the trademark of WebMD Health Services Group, Inc.

Blue Cross and Blue Shield of Hawaii

Health Information Technologies

Blue Cross and Blue Shield of Hawaii launched a $20 million initiative to promote the adoption of electronic health records (EHRs) across its physician network and assist provider groups with the cost of implementing the systems. EHRs allow providers and hospitals to share patient information across a secure network, ensuring that patients receive well-coordinated, comprehensive and efficient care.

In addition, the Plan supports the Allscripts e-prescribing system, a secure, interoperable network that connects physicians, pharmacies and hospitals. Using this e-prescribing system, physicians can access patient medical records at the point of service, giving them real-time data on past and present medications and recent diagnoses and procedures. The system also flags potential adverse drug events related to drug interactions or patient allergies, allowing the physician to change or cancel the order.

HMSA Initiative for Innovation and Quality

Blue Cross and Blue Shield of Hawaii introduced the HMSA Initiative for Innovation and Quality in 2006 with the goal of funding innovative improvements in hospitals and supporting the use of electronic medical records (EMRs) among physicians. Over a three-year period, the program is awarding $10 million annually to acute care hospitals that are working to improve patient care and clinical outcomes.

Meanwhile, the initiative’s physician component is distributing $20 million in grants to help provider groups adopt EMRs. In partnership with select vendors, the program is hoping to help 1,000 physicians adopt these systems, creating a comprehensive, coordinated network across the state.

Blue Cross of Idaho

Idaho Health Data Exchange

Blue Cross of Idaho partnered with a coalition of doctors and hospitals and the State of Idaho to create a health data exchange that facilitates access to patient records across the healthcare spectrum. The collaborative effort aims to ensure that health information is available at the point of care, helping to stem medical errors, avoid duplicative services and reduce health costs. The initiative also supports disease management efforts, encourages greater member participation in healthcare decisions and furthers research on evidence-based care techniques.

Regence BlueShield of Idaho

Changing the Quality of Healthcare through Collaboration

In every Regence market, the Plan supports community partnerships that are committed to achieving measurable improvements in regional healthcare quality. The organizations Regence supports include:

Washington – Puget Sound Health Alliance (click here to learn more about the Puget Sound Health Alliance and the Community Checkup Report released by the organization)
Oregon – Q Corp
Idaho – Employers’ Health Coalition of Idaho
Utah – Partnership for Value-Driven Health Care

To learn more about Community Collaboratives, please click here.

Data Exchanges

The future of healthcare is in electronic medical records and common information systems. Regence supports and is involved in data exchanges in each of its regions. The benefits of electronic medical records to providers and patients include:

Immediate, electronic information sharing of laboratory results;
A comprehensive patient medical history readily available, electronically, on demand;
Improved health safety as medical providers have all pertinent medical information easily on hand for quicker diagnoses and treatment; and
Less duplication in care and greater collaboration between patients and providers.

myRegence.com

MyRegence.com is designed to help advise Regence members on healthcare and lifestyle options, navigate them through the healthcare system and reward those who make healthier choices. With myRegence.com, members can find all their health-related resources in one place.
Members learn how to become more accountable for their health and better navigate the healthcare system by discovering interactive tools to research treatment options, cost-quality comparisons of hospitals, wellness programs and activities and incentives for making healthy lifestyle choices. Some of these key tools and resources include:

A nationwide provider search, along with member reviews and detailed provider profiles to find the right provider for the member
Ability to view a summary of personalized benefits, coverage or current claims
Original videos, podcasts and articles with helpful fitness tips, healthy recipes and fun, informative content about the latest health topics
Management of members’ health history through their own personal health record
A support system to help members get active, lose weight, sleep better or just live healthier through community message boards
Recognition for healthy lifestyle choices and the opportunity to earn rewards points toward gift cards from major retailers in their area
Live Help instant chat with Regence customer support representatives available and accessible from any page on the site

Blue Cross and Blue Shield of Illinois

BlueEdge Plan Options

Blue Cross and Blue Shield of Illinois’s high-deductible BlueEdge plans provide members with greater control over their personal healthcare spending. BlueEdge products include coverage for preventive and wellness visits, and members can use their Health Reimbursement Arrangements (HRAs) or Health Savings Accounts (HSAs) to pay for eligible expenses, which count toward their deductible. In addition, BlueEdge products provide access to innovative, easy-to-use online tools that help members budget for healthcare expenses, keep track of their spending account, review costs for common services, research and compare area hospitals and find a network doctor.

Collaborative e-Prescribing Program

Blue Cross and Blue Shield of Illinois launched and provided the first $1 million in funding for a statewide e-prescribing system that is open to network physicians, health insurance carriers, pharmacies, technology providers, professional societies and others. Since the program’s inception in April 2007, participating physicians have written approximately 467,500 electronic prescriptions. In a single month, the system detected more than 4,500 potential adverse drug interactions and more than 700 potential allergic reactions; nineteen percent of those alerts resulted in a change or cancellation of the proposed prescription.

HealthShare Hospital Comparison Tool

Blue Cross and Blue Shield of Illinois’s Hospital Comparison Tool, provided by HealthShare Technology, Inc., allows consumers to research and compare individual hospital outcomes data for more than 100 diagnoses and procedures, as well as hospital performance factors such as mortality, length of stay, complications, costs and patient volume. The Hospital Comparison Tool is based on healthcare data reported to state and federal government agencies and includes hospital survey results from the Leapfrog Group, a consortium of more than 130 large companies that advocate for quality improvement.

Patient Clinical Summary

In an effort to assist providers and members who may have been displaced by flooding in June 2008, Blue Cross and Blue Shield of Illinois (BCBSIL) developed an online system that includes patient clinical summaries (PCS) for BCBSIL members. Used during natural disasters when providers do not have access to patients’ medical records, the PCS system provides a “snapshot” of BCBSIL members’ medical histories, including laboratory results and prescription information.

Personal Health Management Information Program

Blue Cross and Blue Shield of Illinois’s Personal Health Management Information Program offers members a personal health record (PHR) and online, interactive tools to help them manage their health. The program relies on a comprehensive claims database to facilitate case management and online consumer education.

Physician Transparency Pilot

To provide members with better access to information on provider cost and quality, Blue Cross and Blue Shield of Illinois (BCBSIL) launched its Transparency Pilot Program in April 2008. The initiative, which was limited to Illinois PPO physician and hospital data, gave a sample population of BCBSIL PPO members access to information about their physicians’ quality and cost efficiency. The Plan developed profiles for each internal medicine, pediatrics, OB-GYN, mixed specialty, cardiology, orthopedics, general surgery, ophthalmology and family practice group that had claims volumes large enough to meet BCBSIL reporting thresholds.

Service in the Neighborhood for Seniors

Blue Cross and Blue Shield of Illinois’s Service in the Neighborhood for Seniors is a community education and outreach program that provides unbiased information about Medicare and other insurance programs. The program offers educational programs and one-on-one counseling and has a presence at community events such as health fairs, senior expos, picnics and the Senior Olympics. Most of the program’s free events – which provide primary Medicare and supplemental insurance information in a lecture, quiz and game format – are held at hospitals, banks, libraries, senior centers, park districts, local malls, retirement homes and churches. In addition, the program offers a workshop on Medicare paperwork, a Prescription Drug Review program with a licensed pharmacist and a “Seniorcise” program that teaches seniors how to stay fit and active.

Anthem Blue Cross and Blue Shield (Indiana)

American Imaging Management, Inc.™

Anthem Care Comparison

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Wellmark Blue Cross and Blue Shield of Iowa

Blue Priority HSA

Wellmark Blue Cross and Blue Shield of Iowa’s Blue Priority Health Savings Account (HSA) products for small employers and individuals combine a high-deductible health plan with an HSA, providing affordable coverage while allowing consumers to take more control of their healthcare dollars. Blue Priority also offers a health reimbursement arrangement to large employers that can be paired with any type of plan with a deductible of more than $1,000.

Health Information Technology

To help members make informed healthcare decisions, Wellmark Blue Cross and Blue Shield of Iowa supports efforts to bolster the use of health IT resources. For example, the Plan offers around-the-clock nurse triage and decision-support services, customized worksite wellness programs, personal health assessments and chronic disease and specialty condition management programs. Wellmark also helps physicians deliver the right care at the right time by giving them access to fully integrated electronic personal health records.

Telemedicine Programs

To ensure that members have access to the highest-quality care available, Wellmark Blue Cross and Blue Shield of Iowa helps fund programs that connect residents in rural areas with specialists across the state. Using a secure electronic platform to deliver telemedicine services, the programs focus on improving the health of Iowa residents through diabetes management, depression treatment and health literacy education.

Blue Cross and Blue Shield of Kansas

Professional Liaison Committees

Blue Cross and Blue Shield of Kansas (BCBSKS) developed specialty-oriented provider liaison committees to offer healthcare professionals an ongoing voice in developing and implementing policies across the network. The committees are composed of active practitioners and meet regularly throughout the year. The meetings ensure that BCBSKS is in line with the latest technology and business practices and offer network physicians an ongoing forum for sharing feedback with the Plan.

Telemedicine Programs

Blue Cross and Blue Shield of Kansas reimburses for telemedicine consultations that provide members in rural areas with greater access to specialists. Physicians can collaborate on diagnoses with healthcare professionals hundreds of miles away using secure, closed-circuit audiovisual connections, ensuring that patients in outlying areas receive high-quality care without having to travel far from home.

Anthem Blue Cross and Blue Shield (Kentucky)

American Imaging Management, Inc.™

Anthem Care Comparison

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Blue Cross and Blue Shield of Louisiana

AccessBlue

Blue Cross and Blue Shield of Louisiana's AccessBlue - a secure, online self-service tool - offers a range of features to help members manage their accounts. Using AccessBlue, members can:

Review their claims history and status
Get their Blue Health Record, a three-year look back at all claims filed with Blue Cross on their behalf
Change an address or update personal information (if their employer participates)
Order a replacement ID card or benefit booklet (if their employer participates)
Create a Personal Health Record for themselves and their family
Use other tools and resources that will help them compare plans, research hospitals and learn about common medical conditions and treatments

Individual members can also pay their bills online through AccessBlue.

In addition to these password-protected tools, Blue Cross' website offers access to many other health and wellness programs and services. Members can go online to find a doctor in their network, learn about their prescription drug coverage, search for the right policy for their needs or review medical coverage policies. They can also link to the Plan's award-winning wellness program, the Louisiana 2 Step, and an extensive library of helpful medical information.

Comparing Louisiana Hospitals

Blue Cross and Blue Shield of Louisiana (BCBSLA) assists members who wish to research services and value among Louisiana hospitals by connecting them with Louisiana Hospital Inform, an online source for hospital pricing and quality offered by the Louisiana Hospital Association. Features include overall hospital profiles, pricing for inpatient and outpatient services and a quality assessment. Members also have access to the Blue Cross and Blue Shield Association's National BlueCard® Directory to research participating hospitals and doctors in other states. The Plan provides access to online tools for special populations as well, including Federal Employee Program members, employees of the East Baton Rouge City-Parish group and those seeking to locate nearby behavioral health specialists.

Additionally, BCBSLA recently implemented a new hospital comparison tool for members to use when selecting a healthcare facility. A direct link to the new tool, called Hospital Compare, is included with each participating hospital's information in Blue Cross' searchable online provider directory. A member who clicks on the link can view and compare information that hospitals have reported to the Centers for Medicare & Medicaid Services. This free online service includes quality information on certain processes that the hospital performs and survey results of patients' hospital experiences. It was created to provide factual information so members can choose which hospital best fits their needs and preferences. Members can view the information on one hospital or select more than one to compare side-by-side.

The Plan's online directory also provides a direct link to each hospital's website, if provided. Members can link from the hospital affiliation information included in the physician directory to the hospital(s) where a physician admits, and there is a list of affiliated physicians available within each hospital's directory information. The expanded hospital information also includes Blue Distinction Center designation, if applicable, and Joint Commission and/or National Committee for Quality Assurance (NCQA) accreditations.

Professional provider directory information includes demographic information such as medical school attended and graduation year, gender, race/ethnic background (voluntarily reported), languages spoken and whether a physician's office is accepting new patients. Providing as much information as possible about network providers allows members to select a provider based on their individual preferences. The result fosters further healthcare transparency. Patients may make better informed healthcare decisions and form longer-lasting relationships with their providers.

ePrescribing Programs

Blue Cross and Blue Shield of Louisiana has been a leader in electronic prescribing and online formulary technology, conducting successful programs with two industry leaders: ePocrates and ZixCorp. In 2005, the company began making its formulary available through ePocrates, a drug reference guide designed for the Palm OS and Pocket PC platforms and through ePocrates Rx OnlineTM, available for Internet-connected desktop computers. The ePocrates technology enables physicians and other healthcare professionals in Blue Cross' networks to compare the co-payment levels of prescription drugs for their patients and review the most up-to-date information on dosing and drug interactions before a prescription is written.

Physicians access the ePocrates application with their handheld PDAs right in the exam room. They can immediately see the latest list of drugs and the associated Blue Cross insurance coverage, scan the different drug options and check for drug interactions involving a patient's current medications. The ePocrates drug reference allows physicians to enter up to 30 different medications that a patient may be taking and check for drug interactions.

All ePocrates products are easily downloadable via the Internet and are currently used by more than 600,000 U.S. physicians, including thousands in Louisiana.

Blue Cross partnered with ZixCorp in 2006 to implement a pilot program that provided more than 500 network physicians with PDAs and ePrescribing software to electronically transmit prescriptions. In fact, Blue Cross led the state of Louisiana with the first ePrescribing sponsorship program offered by a commercial plan. Like ePocrates, ZixCorp's ePrescribing software reduces unnecessary costs, improves patient safety and convenience and enhances practice efficiency.

High-volume prescribing physicians were invited to participate in the program, which gives them the power to order prescriptions through a secure wireless mobile PDA or secure website and deliver them electronically to the patient's preferred pharmacy. Mobility enables the ePrescribing software to provide clinical decision support at the point of care with real-time access to a drug reference guide, as well as patient-level eligibility, formulary and co-payment information to aid the prescriber in selecting the most cost-effective prescription based on the patient's benefits and healthcare needs. The application also provides comprehensive drug-to-drug and drug-to-allergy interaction alerts based on patient-specific dispensed drug history.

The ePrescribing program has been extremely successful, increasing both generic fill rates and formulary compliance.

Online Medical Policies

Blue Cross and Blue Shield of Louisiana regularly develops and revises medical policies in response to rapidly changing medical technology. Because benefit determinations are made based on the medical policy in effect when services are provided, the company is committed to keeping the provider community up to date through its quarterly printed provider newsletter, monthly e-newsletter and online provider information portal, iLinkBLUE.

Medical policies also are posted on the company's website, where customers registered for the secure member self-service tool, AccessBlue, can review them.

Striving for Provider Satisfaction

Blue Cross and Blue Shield of Louisiana works hard to maintain excellent relations with providers statewide. The Plan was ranked No. 1 for five straight years in the Blue Cross and Blue Shield Association's BlueCard® provider satisfaction survey. No other payer in the state can offer access to every full-service acute-care hospital and almost 90 percent of all physicians in its provider networks. The company has a dedicated unit for provider services within its Network Administration Division, and it maintains Local Area Physician Advisory Councils (LAPAC) in the four major geographic regions of the state: Baton Rouge, New Orleans, Shreveport and Lafayette.

Anthem Blue Cross and Blue Shield (Maine)

American Imaging Management, Inc.™

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

CareFirst BlueCross BlueShield

Portfolio of Web-based Resources

Through CareFirst BlueCross BlueShield’s website, members can access an array of online tools and resources that offer answers to common questions, help determine the best and most cost-effective treatment options and provide advice on managing personal health. Among them:

Coverage Advisor – Helps members make informed decisions when selecting a health plan by using a survey to determine healthcare needs and providing estimates of annual costs, including out-of-pocket expenses, for each selected plan
Find a Doctor – Offers members an updated listing of physicians and specialists within a specified area
Hospital Comparison Tool – Allows users of CareFirst’s “My Account” portal to view a side-by-side comparison of local hospitals, listing the number of procedures completed, average complication rates, length-of-stay data and other relevant information
Treatment Cost Estimator – Provides members of select plans with medical cost information for 22 major practice categories, including maternity care and infection and cardiac treatment. Members receive an estimated cost for treating various conditions, as well as an average duration of treatment by condition.
Drug Pricing Tool – Enables members with most prescription plans to enter the name, dosage and personal pharmacy for a prescription drug and receive an estimate of expected costs
My CareFirst – Offers an online compendium of information and resources for members to manage their personal health, including an online health risk assessment

Blue Cross and Blue Shield of Massachusetts

e-Visits with RelayHealth

Using the RelayHealth system, Blue Cross and Blue Shield of Massachusetts allows patients to receive and physicians to be reimbursed for non-emergency and follow-up care provided through online consultations. In addition to reducing the need for office visits, the Web-based consultations are archived to ensure accurate documentation and care continuity. Members can also use the system for a variety of other purposes, including scheduling appointments, receiving normal lab results and requesting prescription renewals or refills.

HRA/HSA-Eligible High-Deductible Health Plans

Blue Cross and Blue Shield of Massachusetts offers a range of high-deductible health plans paired with Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs), including HMO Blue, Blue Care Elect and HMO Blue Preferences. In addition to offering affordable premiums, these plans give members greater control over their personal medical expenses.

Massachusetts e-Health Collaborative (MAeHC)

Spearheaded by Blue Cross and Blue Shield of Massachusetts, the Massachusetts e-Health Collaborative (MAeHC) has united the state's major healthcare stakeholders in an effort to create an electronic health record (EHR) system that will enhance care quality, safety and efficiency. The Plan has committed $50 million to fund MAeHC’s demonstration project phase, which will pool the resources, talent and experience of the collaborative’s 34 member organizations. To date, MAeHC has selected three communities – Greater Brockton, Greater Newburyport and Northern Berkshire – as sites for assessing the feasibility of implementing a communitywide EHR over a 24- to 36-month period.

Blue Cross Blue Shield of Michigan

Flexible Blue Product

Blue Cross Blue Shield of Michigan’s Flexible Blue product, a consumer-directed coverage option, aims to make healthcare more affordable while providing comprehensive health benefits. Consumers gain greater control over their healthcare decisions through tools that enable them to customize low-premium coverage options. Additionally, tax-advantaged features such as health savings accounts, health reimbursement arrangements and flexible spending accounts allow members to seamlessly monitor and manage their personal healthcare spending through the Blue Healthcare Bank.

Southeastern Michigan e-Prescribing Initiative

To accelerate the adoption of e-prescribing standards and technology, Blue Cross Blue Shield of Michigan in 2005 partnered with several large automakers and healthcare providers to form the Southeastern Michigan e-Prescribing Initiative (SEMI). With support from regional pharmacies and data connectivity from RxHub and SureScripts, SEMI hopes to reduce medication errors and improve care quality, as well as reduce prescription drug costs by promoting greater use of generics and optimizing formulary compliance.

To drive adoption of e-prescribing, SEMI subsidizes physician groups' implementation costs and provides incentives for using the system. To date, the program has achieved impressive results, including:

Over 3,000 physicians enrolled

More than 350,000 prescriptions transmitted monthly

Approximately 25,000 prescription changes per month resulting from warnings of potential adverse drug events such as drug-to-drug interactions and patient allergies

In addition to participation in the SEMI initiative, BCBSM has offered a free two-year Web solution for e-prescribing through the WebDENIS provider portal. To date, 1,000 physicians have gone live with the technology, and nearly 700,000 prescriptions have been processed electronically. BCBSM also offers a hand-held device to the pilot participants who prefer wireless access.

The Unadvertised Brand Campaign

Blue Cross Blue Shield of Michigan launched the Unadvertised Brand Campaign to educate consumers and healthcare providers about the safety, effectiveness and value of generic drugs. Through the campaign's website, consumers and healthcare professionals can access valuable educational resources such as a cost comparison calculator for the 100 most commonly prescribed drugs. Users can also find information about newly available generics, obtain information on anticipated first-time generics and review FDA resources on various generic drugs. Since the campaign's inception, the rate of prescriptions being filled with generic drugs has increased from 37.7 percent to well over 60 percent.

WebDENIS Electronic Information System

Blue Cross Blue Shield of Michigan's WebDENIS system offers providers online access to members' health insurance information in addition to Medicare and Medicaid patient eligibility. Using this secure Internet platform, providers may instantly review patient eligibility and coverage benefits and determine their deductible levels and co-payment amounts. The system also offers access to provider manuals, publications, medical code indices and other resources designed to facilitate efficient care delivery. Currently, 95 percent of Michigan providers use WebDENIS, and more than 90 million transactions are completed through the portal annually.

WebMD Suite of Decision-Making Tools

Blue Cross Blue Shield of Michigan members have access to the Healthcare Advisor, a suite of online tools designed to assist with healthcare decision-making and encourage patients to take greater control of their health. Among them:

Hospital Advisor – Allows members to locate and compare hospitals in their geographic area based on search criteria such as patient volume, complication and infection rates and hospital reputation
Physician Selection Advisor – Generates a list of providers matching criteria that members designate as being important to them
Coverage Advisor – Helps members understand what healthcare services their family is likely to need and provides cost estimates for that care, enabling members to determine appropriate contribution levels for their HSA/HRA accounts, as well compare different benefit plans offered by their employer

Blue Cross and Blue Shield of Minnesota

HealthcareScoop®

Through a partnership with Consumer Aware®, an organization dedicated to helping consumers make informed healthcare decisions, Blue Cross and Blue Shield of Minnesota promotes an online community known as HealthcareScoop to members, employers and providers. The free website enables patients to share their experiences with the healthcare system, learn strategies for coping with a new diagnosis and obtain information about various procedures and treatments. HealthcareScoop provides a venue for consumers to share individual patient stories and experiences with each other. Users can search, sort and rate the usefulness of different stories, as well as comment on other consumers’ stories on the site.

Minnesota Health Information Exchange (MN HIE)

Through a public-private partnership with HealthPartners, Medica, UCare, Fairview Health Services and the Minnesota Department of Human Services, Blue Cross and Blue Shield of Minnesota helped launch the Minnesota Health Information Exchange (MN HIE). With patient consent or in the event of a medical emergency, MN HIE provides immediate access to a patient’s medication history for the past 12 months. By leveraging a single technology platform to safely and securely exchange medical information, healthcare providers in Minnesota will have immediate access to vital medical information to quickly diagnose and treat patients. These capabilities help improve patient safety, increase efficiency among multiple healthcare providers and reduce administrative costs.

When it went live in 2008, MN HIE became one of the nation’s largest health information exchanges, serving more than three million Minnesotans. Future electronically based services will include lab results, immunization records and electronic prescriptions.

Minnesota Telehealth Network

Blue Cross and Blue Shield of Minnesota supports telemedicine applications designed to expand rural residents’ access to specialty consultations. Using digital videoconferencing technology via secure Internet connections, the Minnesota Telehealth Network is led by Tri-County Hospital in Wadena. Blue Cross not only reimburses the consulting physician but also pays the facility fee for patient services.

Blue Cross & Blue Shield of Mississippi

Be RxSmart – It’s Your Choice Prescription Drug Benefit

Blue Cross & Blue Shield of Mississippi's Be RxSmart tool offers members an online resource for researching which prescription medications are most cost effective for a given health condition. Members can identify generic alternatives to discuss with their physicians and learn about lifestyle modifications that, if properly implemented, could eliminate the need for prescription drugs altogether. To learn more, please click here.

Anthem Blue Cross and Blue Shield (Missouri)

American Imaging Management, Inc.™

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Blue Cross and Blue Shield of Kansas City

Electronic Connectivity with RelayHealth

Blue Cross and Blue Shield of Kansas City adopted the RelayHealth connectivity tool in January 2006 to facilitate communication between members and physicians. For example, the Web-based RelayHealth system allows patients to schedule appointments electronically and have confidential, online consultations with their provider. The tool also facilitates e-prescribing and the online delivery of lab results. In addition to improving efficiency and reducing the need for office visits, RelayHealth archives each patient-physician interaction to ensure accurate documentation and care coordination.

Blue Cross and Blue Shield of Montana

HRA/HSA-Qualified Plans

Blue Cross and Blue Shield of Montana offers high-deductible health plans (HDHPs) paired with Health Savings Accounts (HSAs) for individuals and small employers and HDHPs paired with Health Reimbursement Arrangements (HRAs) for large employers. These products provide affordable coverage options while giving members more control over their healthcare dollars.

Blue Cross and Blue Shield of Nebraska

Clinical Guidelines for Providers

To promote adherence to evidence-based guidelines, Blue Cross and Blue Shield of Nebraska offers various tools and resources for physicians who treat chronically ill patients. For example, the Plan regularly updates clinical practice guidelines to reflect nationally endorsed best practices in chronic disease management and preventive care. In addition, physicians may instantly access online resources on conditions such as asthma, cardiovascular disease, chronic obstructive pulmonary disease, diabetes and acid-related stomach disorders.

Nebraska BLUEconnect

For the Nebraska BLUEconnect program, Blue Cross and Blue Shield of Nebraska developed an electronic data interchange (EDI), the preferred method of submitting claims to the Plan. The initiative offers provider training, promotes adherence to EDI regulatory requirements and recruits other physicians to implement the program. BLUEconnect’s secure, electronic platform not only eases physician offices’ administrative burden but also facilitates more efficient claims processing.

Anthem Blue Cross and Blue Shield (Nevada)

American Imaging Management, Inc.™

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Zagat Health Survey

Trust
Communication
Availability
Environment

In addition, the survey will feature a comments section, allowing members to expand on their ratings. The survey and results are free of charge to members via the Plan’s website.

Anthem Blue Cross and Blue Shield (New Hampshire)

American Imaging Management, Inc.™

Anthem Care Comparison

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

New Hampshire E-Prescribing Program

Anthem Blue Cross and Blue Shield’s New Hampshire e-prescribing program creates turnkey access to e-prescribing tools – including resources to improve wellness and educate members on healthy living – from nearly any device with an Internet connection. In conjunction with the program, Anthem offers physicians free access to e-prescribing software, a free mobile pocket PC and a discounted wireless telecommunication plan to access real-time patient eligibility, formulary and medication history information. In addition, the Plan added an important enhancement to the program, creating a health information technology tool that allows physicians to:

View diagnoses of their Anthem patients independent of which physician made the clinical diagnosis
View procedural history for their Anthem patients independent of treating physician
Obtain contact information for other physicians who ordered clinical tests on Anthem members
Perform an eligibility check for most PBMs
See a member specific formulary for most PBMs
Obtain patient drug history for most PBMs
Electronically prescribe for any patient regardless of payer

These point-of-care advancements facilitate safe, effective and cost-effective clinical decision-making and are provided to physicians at no cost. Anthem is also working with the New Hampshire Citizens Health Initiative, a partnership of the state’s healthcare providers, pharmacists, public groups and the National ePrescribing Patient Safety Initiative, to expand the program.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Horizon Blue Cross and Blue Shield of New Jersey, Inc.

e-Prescribe Initiative

Horizon Blue Cross and Blue Shield of New Jersey worked with providers to install e-Prescribe software, allowing physicians to access patient medical information at the point of service from a PDA or Internet-ready device. Real-time access to the patient’s medical history allows the physician to view past prescriptions and receive alerts about potential adverse drug events such as drug-to-drug interactions or patient allergies, improving the efficiency and safety of the prescribing process. The e-Prescribe software also offers significant cost savings to both providers and patients through more efficient interactions with pharmacies, improved formulary compliance and alerts of less expensive generic alternatives. To date, more than 1,500 physicians have installed the e-Prescribe software through the Horizon program.

My Health Manager

Horizon Blue Cross and Blue Shield of New Jersey developed My Health Manager, powered by WebMD, to enable members to take greater control of their healthcare decisions. The online tool incorporates health and wellness components such as a Health Assessment Tool, Hospital Advisor, Treatment Cost Advisor and Personal Health Record, as well as an index of informational resources on conditions and symptoms, fitness, nutrition and smoking cessation.

Health Care Service Corporation, a Mutual Legal Reserve Company | Blue Cross and Blue Shield of New Mexico

Blue Access Online Portal

Blue Cross and Blue Shield of New Mexico launched Blue Access, an online portfolio of healthcare tools, to help members make more informed healthcare decisions and become more engaged in their personal wellness. These tools include:

Hospital Comparison Tool – Allows members to compare individual hospitals' outcome data for specific diagnoses and procedures, as well as evaluate and select facilities that best meet their care needs
Treatment Cost Advisor – Provides cost information for common healthcare services based on demographic and geographic information, helping individuals make cost-effective decisions when seeking care
Personal Health Manager – Assists members in taking greater control of their personal health with a health risk assessment, advice on healthy lifestyles from healthcare professionals and access to a personal health record

Personal Health Manager Program

Blue Cross and Blue Shield of New Mexico offers its members a Personal Health Manager, which is an online, interactive platform to help maintain and improve wellness. Through the Web-based program, members may complete a health risk assessment and receive a report outlining potential health risks, along with suggestions for healthier living from nurses, trainers, dietitians and health coaches. Members may also keep track of vital health information through a personal health record, which is populated with claims-based and user-submitted information about medications, procedures, diagnostic test results and conditions. The program also offers a reminder system to notify members of upcoming appointments and routine screening recommendations.

BlueCross BlueShield of Western New York and BlueShield of Northeastern New York

My Rx Choices Program

BlueCross BlueShield of Western New York and BlueShield of Northeastern New York's My Rx Choices program offers members a simple, personalized menu of medication choices. Specifically, the program presents members with lower-cost alternatives to their current medications – including generic therapies and preferred brand-name prescriptions – based on their plan’s drug benefit coverage. Members can print My Rx Choices information and discuss lower-cost options with their physicians, switching to the more cost-effective medication if the prescriber agrees. An analysis of the program has shown that members are 58 percent more likely to switch to a more cost-effective medication or lower-cost pharmacy channel when using the comparison shopping tool.

Suite of Online Healthcare Tools

BlueCross BlueShield of Western New York and BlueShield of Northeastern New York have created a suite of online tools and resources for their members in hopes of empowering them to take a greater role in the healthcare decision-making process. These tools include:

Healthcare Advisor – Helps members research more than 100 conditions and procedures; select a hospital based on experience, reputation and results; and estimate the cost of care for a wide range of medical services and pharmacy expenses
Coverage Advisor – Provides members with side-by-side comparisons of health plans, allows them to create customized health profiles for covered members of their families and offers estimates of healthcare needs and associated costs, including out-of-pocket expenses across different coverage options

Empire Blue Cross and Blue Shield (New York)

American Imaging Management, Inc.™

American Imaging Management (AIM™) – a subsidiary of Empire Blue Cross and Blue Shield’s parent company – promotes the appropriate use of imaging technology and radiation safety. Imaging service quality is advanced by developing and deploying programs to help improve appropriateness of outpatient advanced imaging through the application of evidence-based clinical guidelines. As part of its commitment to providing physicians and members with information to support informed treatment decision-making, AIM’s Patient Safety website offers information on the radiation dosage associated with these advanced imaging modalities. Its interactive human model allows users to select a specific imaging modality/exam and provides the most up-to-date estimated radiation dosage for that modality/exam.

Health Management Corporation®

Health Management Corporation (HMC) – a subsidiary of Empire Blue Cross and Blue Shield’s parent company – takes a proactive approach to personalized health coaching that results in healthier and happier people, less missed work and fewer hospital stays. Its integrated technology helps ensure increased compliance with health guidelines. HMC nurse care managers, physicians, pharmacists, dietitians, exercise physiologists and other healthcare professionals help members navigate the complexity of accessing healthcare – from the most difficult, costly and debilitating medical conditions that increase healthcare costs to the wellness programs that help prevent them. In the process, strong relationships form and positive health outcomes are realized. HMC is taking healthcare to a higher level by helping members improve and maintain the health and wellness with a comprehensive suite of health and wellness, disease management and lifestyle management solutions. From prevention and wellness through advanced care management, HMC provides information and guidance on chronic conditions and healthy lifestyles to increase members’ awareness and motivation and help reduce costs for everyone.

MyHealth@Anthem®

Clinical quality and safety support is available to Empire Blue Cross and Blue Shield members through MyHealth@Anthem, an online personal health record (PHR) powered by WebMD that converts medical claims into a longitudinal PHR and also includes drug and laboratory information that members can share with physicians. Members can access their up-to-date health information and receive clinical alerts for drug safety and care options. Members can also learn more about planned or contemplated surgery through the online surgical procedure guide, which includes animated video depictions of surgery. Specific content includes:

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

PrecisionRx Specialty Solutions – a subsidiary of Empire Blue Cross and Blue Shield’s parent company – strives for 100 percent guideline adherence, and its new state-of-the-art medication distribution center in Indianapolis helps ensure optimal dosages and medication safety. Care coordinators work directly with members to schedule timely delivery of medications; educate and monitor drug regimens for diseases such as hepatitis B, hemophilia, rheumatoid arthritis and cancer; and encourage therapy adherence. Clinical pharmacists evaluate diagnoses to determine the appropriate therapy, review prescriptions for accuracy and safety and provide individualized counseling, while registered nurses track the progress of treatment and develop goals for managing potential side effects.

Resolution Health™, Inc.

Resolution Health, Inc. (RHI™) – a subsidiary of Empire Blue Cross and Blue Shield’s parent company – provides actionable information to consumers through clinical messaging technology. RHI integrates and analyzes medical and laboratory claims data through an evidence-based rules engine. The output of this analysis generates clear, actionable clinical alerts or messages regarding health improvement, patient safety and member cost-saving opportunities. These clinical messages for optimal care are developed by faculty at Harvard Medical School. There are member and physician messages currently deployed that identify gaps in care that a member is receiving, including whether a medication or laboratory test is required for a specific clinical condition, a member is not being adherent to a therapy prescribed or preventive clinical guidelines such as cancer screening are not being followed.

Subimo™ Hospital Comparison Tool

The Subimo Hospital Comparison tool allows Empire Blue Cross and Blue Shield members to select two or more hospitals to compare side by side so they can look at the hospitals’ experience with specific medical conditions or procedures. The tool delivers comparative information in three categories: quality and experience; reputation; and characteristics such as whether the institution is a teaching hospital, performs many high-tech procedures and/or has an onsite ICU. By allowing members to assign their own level of importance to each available quality factor, the Subimo Hospital Comparison tool generates a personalized, prioritized list of hospitals matching the member’s own quality preferences. Subimo is the trademark of WebMD Health Services Group, Inc.

Excellus Blue Cross Blue Shield (New York)

Generic Drug Savings Calculator

Excellus BlueCross BlueShield provides members with access to an online drug savings calculator that demonstrates cost savings for using generic rather than name-brand prescription medications.

Blue Cross and Blue Shield of North Carolina

ePrescribe Program

As part of its ePrescribe program, Blue Cross and Blue Shield of North Carolina (BCBSNC) identified 1,000 network physicians with high prescribing volumes and gave them a handheld PDA, wireless network hardware and a software license free of charge. Using claims data, BCBSNC uploaded members’ medical information into each physician’s e-prescribing system. The technology provides point-of-service access to formulary benefits and generic alternatives, as well as alerts regarding potential adverse drug events (ADEs) such as drug interactions and allergic reactions.

Since the launch of the ePrescribe program, more than 1,000 physicians have enrolled, and generic drugs have accounted for 59 percent of electronic prescriptions. In addition, 29 percent of orders have been flagged for potential ADEs, and two percent have been halted and changed based on patient allergy alerts. To learn more about the ePrescribe program, please visit BCBSNC’s website.

Healthcare Cost Estimator Tool

Blue Cross and Blue Shield of North Carolina developed the Healthcare Cost Estimator as a Web-based resource that enables members to view average prices paid by the Plan for physician office visits, diagnostic procedures, prescription drugs and other treatments. The tool helps members estimate the expected costs of certain healthcare services and enables them to make cost-effective choices when selecting a provider.

BlueCross BlueShield of North Dakota

Blue Insight

Blue Cross Blue Shield of North Dakota (BCBSND) is dedicated to educating its members. Blue Insight is a webpage designed to help North Dakotans better understand BCBSND and to explain what the company is doing to help curb the high costs associated with healthcare. Blue Insight tells the good and bad news about healthcare in North Dakota and shows how BCBSND is leading the way with solutions that focus on quality, value and service.

Blue Insight also features videos of BCBSND employees addressing their concerns about healthcare in North Dakota and includes the “10 Steps of Health Coverage.” There are sections on statistics and industry information, and “All insights” lists health issues and what BCBSND is doing about them. Another Blue Insight page features an interactive map showing how North Dakota’s medical costs and health premiums compare with other states.

Telemedicine Consultations for Rural Members

Blue Cross Blue Shield of North Dakota reimburses providers for telemedicine consultations in an effort to provide rural members with access to high-quality care without having to travel far from home. Using an extensive, secure network, rural hospitals and providers are able to connect with specialists around the state for remote consultations.

Anthem Blue Cross (Ohio)

American Imaging Management, Inc.™

Anthem Care Comparison

Health Management Corporation®

Integrated Health Records

Launched in June 2007 in partnership with Kettering Health Network and General Motors, Anthem Blue Cross and Blue Shield’s Dayton integrated health record (IHR) pilot program combined 150 clinical and administrative data sets into a single record and deployed these IHRs to 10,000 members and more than 1,000 participating physicians. IHRs combine physician, hospital, ER, laboratory, imaging and pharmacy data into a single record and create a consistently informed virtual care team by connecting physicians, members and clinical data. The resulting information exchange – facilitating point-of-care, shared decision-making – is one of the most promising health IT innovations for advancing healthcare quality.

The program’s first-year results indicate that IHRs are improving health outcomes and generating cost savings among Kettering Health System’s employees and their families. Based on this success, the Plan is expanding the project to a regional pilot in 2009. With continued commitments from General Motors and Kettering Health Network, the initiative will expand to more than 100,000 members, including the Plan’s Ohio-based associates. In addition to physician and member expansion, Anthem is also committed to making significant enhancements to the IHR that will encourage increased use and further integrate quality improvement capabilities.

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

Ohio e-Prescribing Program

To reduce medication errors, adverse drug events and the time physicians spend managing prescriptions, Anthem Blue Cross and Blue Shield’s Ohio e-prescribing program equipped 100 physicians with computer equipment and created an online tool that provides real-time access to members’ medical histories and formulary information. The program offers physicians a financial incentive for adhering to program guidelines and implementing the e-prescribing tool.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Zagat Health Survey

Trust
Communication
Availability
Environment

In addition, the survey will feature a comments section, allowing members to expand on their ratings. The survey and results are free of charge to members via the Plan’s website.

Health Care Service Corporation, a Mutual Legal Reserve Company | Blue Cross and Blue Shield of Oklahoma

Blue Resource Materials

Blue Cross and Blue Shield of Oklahoma developed and disseminate a series of Blue Resource materials to employers and Human Resources professionals to promote health and wellness topics. The resources cover a variety of topics that encourage employers to raise awareness of wellness programs among their workers, such as worksite fitness, preventive health techniques and screenings, and weight management. Employees also have access to an online resource of health information to promote healthy living.

Personal Health Manager Program

Blue Cross and Blue Shield of Oklahoma offers the Personal Health Manager program to provide members with an online, interactive platform to help maintain and improve their wellness. Through the Web-based program, members may complete a health risk assessment, which generates a report outlining potential health risks and strengths, along with suggestions for healthier living from nurses, trainers, dietitians and health coaches. Members may also set up a personal health record (PHR) to keep track of vital health information. The PHR is populated with claims-based and user-submitted information about past and present medications, procedures, diagnostic test results and conditions. The program also offers a reminder system to notify members of upcoming appointments and routine screening recommendations.

Regence BlueCross BlueShield of Oregon

Changing the Quality of Healthcare through Collaboration

In every Regence market, the Plan supports community partnerships that are committed to achieving measurable improvements in regional healthcare quality. The organizations Regence supports include:

Washington – Puget Sound Health Alliance (click here to learn more about the Puget Sound Health Alliance and the Community Checkup Report released by the organization)
Oregon – Q Corp
Idaho – Employers’ Health Coalition of Idaho
Utah – Partnership for Value-Driven Health Care

To learn more about Community Collaboratives, please click here.

Data Exchanges

Immediate, electronic information sharing of laboratory results;
A comprehensive patient medical history readily available, electronically, on demand;
Improved health safety as medical providers have all pertinent medical information easily on hand for quicker diagnoses and treatment; and
Less duplication in care and greater collaboration between patients and providers.

myRegence.com

Members learn how to become more accountable for their health and better navigate the healthcare system by discovering interactive tools to research treatment options, cost-quality comparisons of hospitals, wellness programs and activities and incentives for making healthy lifestyle choices. Some of these key tools and resources include:

A nationwide provider search, along with member reviews and detailed provider profiles to find the right provider for the member
Ability to view a summary of personalized benefits, coverage or current claims
Original videos, podcasts and articles with helpful fitness tips, healthy recipes and fun, informative content about the latest health topics
Management of members’ health history through their own personal health record
A support system to help members get active, lose weight, sleep better or just live healthier through community message boards
Recognition for healthy lifestyle choices and the opportunity to earn rewards points toward gift cards from major retailers in their area
Live Help instant chat with Regence customer support representatives available and accessible from any page on the site

Blue Cross of Northeastern Pennsylvania

Blue Health Solutions

To increase members’ participation in their own healthcare, Blue Cross of Northeastern Pennsylvania offers members access to an array of innovative health management resources through the Blue Health Solutions program. Among them:

MyHealth Solution – Provides an easy-to-use, Web-based resource that can be customized to reflect members’ personal health needs and interests. For example, a confidential personal health assessment helps members understand their health history and the impact it may have on their future health. Members can also maintain their own health records in a secure fashion, use the latest health information and wellness tools, track doctors’ appointments and receive e-mail reminders.
MyHealth Manager – Offers a range of healthcare and lifestyle management programs to help improve members’ quality of life, all supported by one-on-one consultation with personal Care Coordinators. All Care Coordinators are qualified healthcare professionals, including registered nurses, who have the expertise to map out health solutions, provide ongoing support and help members make the right health choices. MyHealth Manager programs include asthma, chronic obstructive pulmonary disease, coronary artery disease, depression and diabetes.
MyHealth Coach – Provides around-the-clock phone access to registered nurses and care providers who can answer any questions regarding members’ health
MyHealth Mart – Features discounts on weight loss, massage therapy and fitness programs and other health-related services
MyHealth Mobile – Allows members to carry their personal health records with them at all times by securely sending them to their mobile phone, where they stay locked away until needed

Tier Zero

Effective July 1, 2008, all fully insured employer groups with Blue Cross of Northeastern Pennsylvania’s multi-tiered prescription drug program were offered Tier Zero, a fourth co-payment plan at no additional premium cost. This tier includes approximately 65 “Best Buy” generic drugs with a co-pay of $0, and it is the nation’s first $0 co-pay tier for generics. Many of these "generic gems" are used to treat chronic, high-cost conditions like diabetes, high blood pressure, heart disease, osteoporosis and gastric reflux. The concept is simple: pair high-cost chronic diseases with the most effective generic medications to treat them.

Tier Zero is designed to increase the use of generic drugs. Research indicates that each one percent increase in the generic fill rate translates to 1.25 percent in pharmacy benefit cost savings. Those savings help slow the rise in health insurance costs. Also, members are more likely to fill and use low- or no-cost prescriptions, keeping them healthier over the long term.

Transparency Initiative

Blue Cross of Northeastern Pennsylvania’s (BCNEPA) transparency initiative, which will be made available on January 1, 2009, aims to provide members with care quality information for physicians and hospitals so they can make informed healthcare decisions. Through a Web link on the BCNEPA member portal, the Plan will publish hospital outcomes and process quality measures provided by WebMD. These quality measures are sanctioned by industry-leading quality organizations, including the Joint Commission, the Leapfrog Group and the Centers for Medicare and Medicaid Services. Specifically, members will be able to access a complications index and patient safety ratings. Members will also have the ability to compare hospitals, and physician demographics and other additional enhancements and measures will become available throughout 2009.

Capital BlueCross

e-Prescribing Initiative

Over 1 million prescriptions have been filled by more than 500 providers who are part of Capital BlueCross’s no-cost e-Prescription program. Providers throughout the Plan’s 21-county service area are eligible to receive free equipment and service as an incentive to promote e-prescribing.

Highmark Blue Cross Blue Shield

Member Responsibility Calculator

In an effort to simplify the billing process, Highmark Blue Cross Blue Shield created the Member Responsibility Calculator, which offers healthcare providers and members a point-of-service, Web-based tool for estimating financial responsibility for medical procedures and services. Available through Highmark’s website, the tool provides members with out-of-pocket expense estimates based on the cost of the service and the individual’s deductible level. The calculator computes upfront costs for more than 150 outpatient procedures across the Highmark network, giving members greater control over their healthcare expenses.

Online Transparency Tools

Highmark Blue Cross Blue Shield offers its members a portfolio of online transparency tools, equipping them to take a more active role in selecting and utilizing health plans that best fit their needs. The tools are designed to engage consumers at every stage of the healthcare decision-making process and assist members in:

Selecting a customizable health plan through insurance product comparisons, a Plan Cost Advisor and the option to enroll in a health savings account, health reimbursement account or flexible spending account;
Using healthcare services through access to cost reference guides and provider selection advisor tools for comparisons of estimated treatment expenses and physician performance on a variety of quality metrics; and
Making healthy lifestyle choices through online wellness programs and access to discounts on alternative medicine products and services from 35,000 practitioners nationwide.

SMART Registry

Highmark Blue Cross Blue Shield developed the SMART Registry to help physicians identify patients in need of routine tests and screenings and better monitor and manage chronic conditions. Under the program, Highmark uses claims data to compile patient-specific and practice-wide reports, which are updated semi-annually and sent to physician practices. All patient-specific information from the registry is available on a single form; based on this information, physicians may choose to order additional tests or refer members for health coaching through Highmark’s Blues on Call® program.

Independence Blue Cross

There are currently no plans in this category.

Triple S Management Corporation

Teleconsulta

Triple-S members have access to Teleconsulta, a health information hotline available 24 hours a day, seven days a week, 365 days a year. Staffed by highly qualified and experienced registered nurses, Teleconsulta answers members’ questions about any health topic. For example, members who are sick, hurt or need health-related advice can receive assistance from nurses, who can help them decide whether they should make a doctor’s appointment or visit an emergency room. The nurses also provide self-care instructions to help members alleviate certain symptoms safely and in the comfort of their home. In addition, Teleconsulta gives members an additional coverage benefit if the nursing professional recommends a visit to the emergency room; in such a case, members are given a number that eliminates or lowers their deductible for that visit (available only in Puerto Rico and dependent on contract stipulations). To learn more, please visit Triple-S’s website.

Blue Cross & Blue Shield of Rhode Island

E-Prescribing Efforts

Blue Cross & Blue Shield of Rhode Island (BCBSRI) supports the adoption of e-prescribing technology, which can help reduce medication errors and enhance provider efficiency. For example, the Plan participates in the Rhode Island Quality Institute’s Statewide E-Prescribing Committee, and it notifies members of physicians’ e-prescribing capabilities through its Provider Finder Web tool. BCBSRI also made the SureScripts-RxHub available to network physicians, giving them real-time access to formulary, member eligibility and medication history information.

HSA-Compatible High-Deductible Health Plans

Blue Cross & Blue Shield of Rhode Island (BCBSRI) offers high-deductible health plans (HDHPs) paired with Health Savings Accounts (HSAs) in an effort to provide affordable coverage options while giving members more control over their healthcare dollars. The Plan’s consumer-driven health plans for groups include BlueSolutions for HSA, which offers an HDHP from BCBSRI and an accompanying HSA through Wells Fargo Health Benefit Services. BCBSRI also offers a HealthMate Coast-to-Coast HDHP that can be combined with an HSA account through an administrator of the employer’s choice. Meanwhile, the Plan’s HealthMate for HSA Direct offers individuals and families an HDHP with 100 percent coverage for well visits, immunizations, pap smears, mammograms and prostate-specific antigen tests before the deductible is applied.

Personal Health Records

Through a partnership with HealthAtoZ, Blue Cross & Blue Shield of Rhode Island offers personal health records (PHRs) that allow members to securely manage their personal and family health information over the Internet. The PHR provides around-the-clock, secure access to health records and facilitates care coordination across multiple providers, with patient information uploaded from claims data for office visits, medical procedures and prescriptions. In addition, the PHR provides e-mail reminders for appointments and medications, as well as alerts of potential adverse drug interactions.

Polypharmacy Program

To reduce the use of duplicative drugs and minimize the risk of adverse interactions, Blue Cross & Blue Shield of Rhode Island’s (BCBSRI) Polypharmacy Program targets physicians of members who take prescription drugs in at least 10 medication classes and have three or more prescribing providers within a three-month period. Through the program, 1,419 providers received mailings identifying 3,267 eligible members, and 475 providers requested member profiles covering 2,230 individuals. The program does not apply to HIV, chemotherapy drugs and anti-neoplastics, antibiotics or immunosuppressants.

Rhode Island Health Literacy Project

Recognizing that low health literacy contributes to medication errors, longer inpatient stays, poor health status and non-compliance with treatment recommendations, Blue Cross & Blue Shield of Rhode Island participates in the Rhode Island Health Literacy Project. The initiative seeks to educate patients about their healthcare needs and promote better comprehension of treatment instructions, helping prevent unnecessary complications and improve patients’ overall health.

Blue Cross and Blue Shield of South Carolina

e-Prescribing Program

Blue Cross and Blue Shield of South Carolina supports the use of e-prescribing across its network, administered by the pharmacy benefits manager Caremark on behalf of the health plan. Network physicians receive free iScribe electronic prescribing software, which offers real-time, point-of-service access to patient medical histories, including past and present prescriptions. The e-prescribing system offers generic alternatives to name-brand prescriptions and instantly alerts the physician of potential medication or allergy interactions to improve the quality, safety and cost-effectiveness of patient care.

My Health Toolkit

Blue Cross and Blue Shield of South Carolina created the My Health Toolkit resource so members can better manage their healthcare and benefits. Members may use the Web-based toolkit to compare health plans, hospital quality performance and drug costs, as well as access a library of medical resources to learn more about specific conditions or treatments. Among the features:

Treatment Cost Estimator – Provides members with estimated medical costs for certain conditions, including the average number of treatment days, average expenses and a brief explanation of specific conditions and procedures
Personal Health Assessment – Includes an online survey to identify personal risk factors and offers guidance on healthier lifestyle choices
Personal Health Record (PHR) – Gives members easy, on-demand access to a consolidated record of their medical information. The "My Care Plan" feature is included in the PHR to integrate member records with disease management programs and offer more comprehensive, coordinated care.
Financial Tools – Allows members with eligible health plans to manage their personal health savings account, health reimbursement arrangement or flexible spending account through a secure, Web-based platform
My Pharmacy Manager – Offers members a personalized, online tool to research prescription drugs, view generic alternatives and receive estimated costs, as well as access a detailed personal medication history. The program also allows members to obtain up-to-date information about their drug benefits and search a Preferred Drug List to promote formulary compliance.

My Insurance Manager Web Precert Program

Blue Cross and Blue Shield of South Carolina launched the My Insurance Manager Web Precert program to streamline the pre-certification process, improve efficiency and reduce costs. The Web-based tool allows providers to receive real-time resolution of some pre-certification requests, verifying member eligibility for procedures, medications and other services. In 2007, this system created efficiencies credited with saving $1.4 million.

Swipe Card Reader Program

Blue Cross and Blue Shield of South Carolina developed the Swipe Card Reader program to offer physicians a sophisticated swipe-card machine that provides patient eligibility and co-pay information within seconds. The swipe card also lets physicians know how much the Plan will reimburse for procedures, promoting transparency in the healthcare system.

Wellmark Blue Cross and Blue Shield of South Dakota

Blue Priority HSA

Wellmark Blue Cross and Blue Shield of South Dakota’s Blue Priority Health Savings Account (HSA) products for small employers and individuals combine a high-deductible health plan with an HSA, providing affordable coverage while allowing consumers to take more control of their healthcare dollars. Blue Priority also offers a health reimbursement arrangement to large employers that can be paired with any type of plan with a deductible of more than $1,000.

Telemedicine Programs

To ensure that members have access to the highest-quality care available, Wellmark Blue Cross and Blue Shield of South Dakota helps fund programs that connect residents in rural areas with specialists across the state. Using a secure electronic platform to deliver telemedicine services, the programs focus on improving the health of South Dakota residents through diabetes management, depression treatment and health literacy education.

For example, the Plan awarded a $47,800 grant to Horizon Health Care, Inc., headquartered in Howard, S.D., for the implementation of a diabetes and depression awareness and treatment program for underserved patients in two rural South Dakota communities. The program will use telemedicine strategies to assist health professionals in educating and empowering patients to manage their conditions and linking them to needed specialty health services.

BlueCross BlueShield of Tennessee

e-Visits with RelayHealth

BlueCross BlueShield of Tennessee supports the use of RelayHealth online doctor-patient communication services as a means to reduce the need for repeat office visits for members with chronic diseases, and will reimburse consulting physicians for participation in the e-visits. The online consultations improve the efficiency and continuity so providers are better able to manage the care of patients with chronic conditions, and offer members access to medical advice and follow up from their doctor without requiring an office visit and the associated copay.

The consultations are archived to ensure accuracy and continuity of care, reducing the risk for potential errors and creating a permanent record of the doctor-patient interaction.

iScribe e-Prescribing Program

BlueCross BlueShield of Tennessee is providing physicians and healthcare professionals with access to the free iScribe e-prescribing tools with software, PDAs, printers and related hardware to implement the health information technology into its practices. With the iScribe system, physicians are able to access updated formulary information at the point-of-service, review patient medical histories, and send prescriptions directly to the pharmacy in a clear, legible format to reduce medical errors and minimize the need for follow ups by the pharmacist. Immediate alerts of potentially harmful allergy and drug-to-drug interactions are sent to the physician, allowing the order to be changed or cancelled prior to a negative event. The program significantly improves the quality, safety and cost-savings of patient care and creates efficiencies to allow physicians and nurses to spend less time on the phone with pharmacies.

Shared Health Initiative

BlueCross BlueShield of Tennessee created the Shared Health initiative to create a patient health record, combining data from claims, lab tests, prescriptions and immunizations, which allows healthcare providers treating the member to access the comprehensive, integrated information through a secure website. The electronic health record creates a patient-centered resource to allow multiple providers treating the same member to better coordinate their care for a more comprehensive, efficient treatment system, reducing redundant and unnecessary tests and procedures.

BCBST developed the database, the largest of its kind in the U.S., and included the entire Medicaid population for the state to promote a more collaborative approach to care.

Health Care Service Corporation, a Mutual Legal Reserve Company | Blue Cross and Blue Shield of Texas

BlueCompare

Blue Cross and Blue Shield of Texas developed the BlueCompare tool to better engage consumers in their healthcare and collaborate with physicians and hospitals to improve quality outcomes and affordability. Using BlueCompare, members and nonmembers can obtain and compare information on a physician’s compliance with evidence-based measures. Physicians are awarded a dark blue ribbon for exceeding expected performance compared to peers or a light blue ribbon for meeting expected performance.

The Plan launched a hospital comparison program through BlueCompare at the end of 2007 using the Blue Cross and Blue Shield Association’s National Provider Performance Measurement and Improvement Program as a model for encouraging consistent care quality and compliance with nationally endorsed measures. The program compares hospital performance based on data from the Centers for Medicare and Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), the Joint Commission and the Leapfrog Group’s Hospital Quality and Safety Survey. An affordability scale is also available based on the Plan's payment experience with the hospital for past medical services.

HealthShare Hospital Comparison Tool

Blue Cross and Blue Shield of Texas implemented the HealthShare Hospital Comparison Tool so consumers can research and compare individual hospital outcome data for more than 100 specific diagnoses and procedures. Members may view hospital performance factors such as average mortality, length-of-stay, rates of complications and frequency of procedure operation to select the best facility to fit their healthcare needs. The tool engages members in the healthcare decision-making process to create more informed consumers of medical services and raise awareness of their personal health conditions.

Personal Health Manager Program

Blue Cross and Blue Shield of Texas offers the Personal Health Manager program to provide members with an online, interactive platform to help maintain and improve their wellness. Through the Web-based program, members may complete a health risk assessment, which generates a report outlining potential health risks and strengths, along with suggestions for healthier living from nurses, trainers, dietitians and health coaches. Members may also set up a personal health record (PHR) to keep track of vital health information. The PHR is populated with claims-based and user-submitted information about past and present medications, procedures, diagnostic test results and conditions. The program also offers a reminder system to notify members of upcoming appointments and routine screening recommendations.

Regence BlueCross BlueShield of Utah

Changing the Quality of Healthcare through Collaboration

In every Regence market, the Plan supports community partnerships that are committed to achieving measurable improvements in regional healthcare quality. The organizations Regence supports include:

Washington – Puget Sound Health Alliance (click here to learn more about the Puget Sound Health Alliance and the Community Checkup Report released by the organization)
Oregon – Q Corp
Idaho – Employers’ Health Coalition of Idaho
Utah – Partnership for Value-Driven Health Care

To learn more about Community Collaboratives, please click here.

Data Exchanges

Immediate, electronic information sharing of laboratory results;
A comprehensive patient medical history readily available, electronically, on demand;
Improved health safety as medical providers have all pertinent medical information easily on hand for quicker diagnoses and treatment; and
Less duplication in care and greater collaboration between patients and providers.

myRegence.com

A nationwide provider search, along with member reviews and detailed provider profiles to find the right provider for the member
Ability to view a summary of personalized benefits, coverage or current claims
Original videos, podcasts and articles with helpful fitness tips, healthy recipes and fun, informative content about the latest health topics
Management of members’ health history through their own personal health record
A support system to help members get active, lose weight, sleep better or just live healthier through community message boards
Recognition for healthy lifestyle choices and the opportunity to earn rewards points toward gift cards from major retailers in their area
Live Help instant chat with Regence customer support representatives available and accessible from any page on the site

Blue Cross and Blue Shield of Vermont

BlueCare Plans with HRA/HSA

Blue Cross and Blue Shield of Vermont (BCBSVT) offers BlueCare plans with Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) options for large and small employers, providing members with greater control over their personal medical expenses. To learn more about BCBSVT’s BlueCare products, please visit the Plan’s website.

Healthcare Advisor

Blue Cross and Blue Shield of Vermont’s Healthcare Advisor gives members access to decision-support tools that enable them to compare healthcare facilities and estimate treatment costs via a secure website. For example, members can evaluate hospitals based on factors they designate as being important to them, view treatment options and cost estimates for a variety of health conditions and procedures and look up information and cost estimates for more than 11,000 prescription drugs, including generic equivalents.

Online Enrollment and Benefits Configurator Tool

Through a partnership with Choicelinx, a vendor specializing in consumer-directed applications and technology solutions, Blue Cross and Blue Shield of Vermont offers online enrollment and provides a Benefits Configurator that allows members to customize their health coverage. The suite of Web-based products and services streamlines health plan processes – including enrollment, life-event benefit changes, member inquiries and benefit design – and gives members better access to health plan information.

Anthem Blue Cross and Blue Shield (Virginia)

American Imaging Management, Inc.™

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Premera Blue Cross

Go2dental Dental Decision Support Tools

Through a partnership with Go2dental.com, Premera Blue Cross provides members with a Web-based suite of tools designed to help them make informed decisions about their oral health and dental expenses. Among them:

Dental Cost Estimator – Provides estimates of expenses for various dental services, from routine checkups to major procedures
Ask a Dentist – Enables members to gain a better understanding of their treatment options
Dental Risk Assessment – Allows members to complete an online survey gauging their oral health and recommending further consultation if necessary

This website also powers the Plan's national dental directory search engine.

HealthCare Advisor

To empower patients to make informed healthcare decisions, Premera Blue Cross offers its members access to the HealthCare Advisor, an online tool with a variety of informational resources. Among them:

Find and Compare Hospitals – Sorts hospitals and facilities according to the type of care they offer and other factors such as procedure volume, complication rates, teaching status and pediatric focus. The tool allows members to find the hospital that best fits their needs anywhere in the country.
Treatment Cost Advisor – Offers pricing information for various conditions, diagnostic tests, drug categories, office visits and outpatient procedures. Members can also select their age range, gender and zip code to determine estimated in-network costs and obtain an overview of the requested procedure.
Health Topic Library – Features informational resources of health topics in three categories: conditions and diseases, procedures and surgery and childbirth.
Tools and Resources – Provides members with lists of important questions to ask their physician during consultations. Members can also participate in community discussion boards to pose questions to other patients or share their personal experiences.

Healthcare Quality Awards Program

Premera Blue Cross’s Healthcare Quality Awards Program recognizes physicians and practices of all sizes that perform well on its Quality Score Card, which captures publicly reported quality and satisfaction data. The awards focus on the following key areas:

Acute Care – Providing recommended care for acute bronchitis and ear infections
Chronic Care – Providing recommended medications for chronic conditions such as asthma, diabetes and coronary artery disease
Preventive Care – Providing the recommended number of well-child visits in the first 15 months of life and performing regular breast and cervical cancer screenings for women

The awards also recognize physicians and clinics for overall quality, gauging their efficiency and performance in acute, chronic and preventive care. Furthermore, to support ongoing improvement, Premera generates and disseminates detailed quality reports to provider groups and clinics statewide. In 2008, the Plan recognized 29 individual physicians and practices at two statewide Healthcare Quality Leadership celebrations.

HRA- and HSA-Paired Health Plans

Premera Blue Cross offers a number of high-deductible health plans for individuals and employers that can be paired with health reimbursement arrangements (HRAs) or health savings accounts (HSAs).

HRAs give employers greater flexibility and control in designing benefit packages and offer employees the convenience of integrating claims processing with the HRA funds made available through their employer. Our benefit packages are designed with high-value medical and prescription pharmacy services including no or minimal out-of-pocket costs. This positions our plans so members can focus on health and wellness through their benefit plan design without cost share barriers.

Our qualified high deductible health plans focus this high value design on robust preventive medical and prescription pharmacy coverage meeting HSA qualifications. This ensures our members have well-tailored health coverage to combined with a fully portable, tax-advantaged HSA.

My Rx Choices

Premera Blue Cross launched the Web-based My Rx Choices program to increase member participation in prescription benefit plans and equip them to make informed healthcare decisions. The tool provides data on the medications they currently take—including the annual cost of those therapies—and reveals the price of lower-cost alternatives that are available for their condition. My Rx Choices also integrates the results of Consumer Reports’ Best Buy Drugs, allowing members to review independently validated information on medications’ safety, effectiveness and price.

One Health Port Medication Information Exchange Project

Premera Blue Cross collaborated with Rx Hub and One Health Port to enable providers to access patients’ medication histories, pharmacy benefits and drug formulary through a secure online portal accessible via an electronic medical record, e-prescribing tool or hospital information system. In addition to creating efficiencies in physician practices, real-time access to patients’ medication histories helps stem medication errors, reduce harmful drug interactions and improve care coordination.

Point-of-Sale Prior Authorization Edit Program

Premera Blue Cross’s Point-of-Sale Prior Authorization Edit Program promotes appropriate medication use by reviewing prescriptions when they are ordered at pharmacies and determining if the request aligns with recommended guidelines. If the prescription therapy is within recommended guidelines, it is filled without interruption. Prescriptions flagged for failing to meet guidelines are referred back to the physician for further consultation, helping ensure that members receive safe, high-quality care. The program has improved care coordination and fostered collaboration among members, pharmacists and providers.

Quality Score Card Program

Helping members make informed healthcare decisions, Premera Blue Cross’s Quality Score Card contains publicly reported quality, pharmacy and satisfaction scores for a number of large clinics across the state. Through the program, Premera recognizes top-performing providers and encourages others to learn from their success. Fifteen prominent medical groups in Washington—serving more than a quarter million people—publicly support and participate in the program.

Since 2002, Washington physicians have steadily improved their adherence to prevailing quality standards, according to the 2008 Quality Score Card. Two key trends in the range of scores across participating clinics have also emerged: scores on the lower end of the range are visibly moving upward, while the upper end of the range has held steady, or even improved.

Specialty Pharmacy Member Clinical Support

Premera Blue Cross developed the specialty pharmacy program to provide support for drug handling, self-administration of medications, disease state counseling and adverse reaction management. The program aims to reduce the costs of specialty drugs for conditions such as multiple sclerosis, rheumatoid arthritis and hepatitis C, as well as ease administrative burden and promote high-quality care for members. Staffed by pharmacists, nurses and patient care representatives, specialty pharmacies meet the unique needs of people taking specialty drugs by offering clinical support and counseling to ensure members are administering their prescriptions properly and following their physicians' recommendations. Specialty pharmacies also coordinate directly with Premera on benefit advisories.

Regence BlueShield

Changing the Quality of Healthcare through Collaboration

In every Regence market, the Plan supports community partnerships that are committed to achieving measurable improvements in regional healthcare quality. The organizations Regence supports include:

•   Washington – Puget Sound Health Alliance (click here to learn more about the Puget Sound Health Alliance and the Community Checkup Report released by the organization)
•   Oregon – Q Corp
•   Idaho – Employers’ Health Coalition of Idaho
•   Utah – Partnership for Value-Driven Health Care

To learn more about Community Collaboratives, please click here.

Data Exchanges

Immediate, electronic information sharing of laboratory results;
A comprehensive patient medical history readily available, electronically, on demand;
Improved health safety as medical providers have all pertinent medical information easily on hand for quicker diagnoses and treatment; and
Less duplication in care and greater collaboration between patients and providers.

myRegence.com

A nationwide provider search, along with member reviews and detailed provider profiles to find the right provider for the member
Ability to view a summary of personalized benefits, coverage or current claims
Original videos, podcasts and articles with helpful fitness tips, healthy recipes and fun, informative content about the latest health topics
Management of members’ health history through their own personal health record
A support system to help members get active, lose weight, sleep better or just live healthier through community message boards
Recognition for healthy lifestyle choices and the opportunity to earn rewards points toward gift cards from major retailers in their area
Live Help instant chat with Regence customer support representatives available and accessible from any page on the site

Mountain State Blue Cross Blue Shield

Blues on Call®

Mountain State Blue Cross Blue Shield offers the Blues on Call program to help members access health information and become more involved in their care decisions. With 24/7 telephone access to a certified health coach, members can ask questions about recent diagnoses, upcoming tests and procedures or general health topics. An integrated disease management program also supports members with diabetes, cardiac conditions, asthma and other illnesses, aiming to address each patient’s total healthcare needs.

In addition, the Plan’s website offers access to the Blues on Call program and enables members to research health topics or communicate with a health coach online. Through the Blues on Call website, members can access the latest information on nationally endorsed care guidelines and evidence-based practices to ensure that they are adhering to self-management recommendations.

Finally, the Healthwise Knowledgebase offers members decision support resources that can help determine when a problem can be treated at home, when to see a doctor and what treatment option best suits the patient’s needs. The resources include a library of health topics, information on various tests and procedures and interactive tools to help members better manage their personal health.

My Benefits Home

Through an online portal known as My Benefits Home, Mountain State Blue Cross Blue Shield offers members a variety of Web-based tools designed to help them take control of their healthcare decisions and lead healthier lives. Among them:

Coverage Advisor – Provides detailed information about medical and drug benefit levels and offers a Plan Cost Advisor for estimating overall and out-of-pocket expenses
Expense Advisor – Allows members to track medical and pharmacy claims, access cost information for certain procedures and treatments and view detailed information on health savings, health reimbursement or flexible spending accounts
Personal Health Advisor – Helps members track their medical history, assess their personal wellness and develop an improvement plan. For example, members have around-the-clock access to a health coach who can help them explore treatment options. They can also use a health risk assessment tool to prioritize lifestyle changes, find online information on preventive care and consolidate their health information in a personal health record. Finally, the portal enables them to view their medication history, order prescription drugs and check the status of medication requests.
Healthcare Provider Comparison – Allows members to locate a nearby pharmacy, access provider quality data and search a network of physicians, hospitals and other providers based on designated criteria
Health Topic Library – Enables members to use a Health Encyclopedia to learn more about diseases and conditions, receive updated information on surgeries and procedures, search for articles on family health topics and obtain tips on making healthy lifestyle choices. The Chronic Condition Guide also helps members with asthma, allergies, high cholesterol and other chronic conditions learn techniques for controlling their illness.

NaviNet Information Portal

In an effort to reduce administrative burden and improve care coordination, Mountain State Blue Cross Blue Shield developed the NaviNet online portal, which offers network providers and facilities real-time access to information about patients’ eligibility, benefits, claims status and other transactions. The secure online program allows physicians and other providers to calculate patient responsibility for out-of-pocket expenses, review claims submissions and search for diagnosis codes by number or condition from any computer connected to the Internet.

Anthem Blue Cross and Blue Shield (Wisconsin)

American Imaging Management, Inc.™

Anthem Care Comparison

Health Management Corporation®

MyHealth@Anthem®

Health Content – The Healthwise Knowledgebase, powered by WebMD Health, is one of the most reliable health resources on the Web, giving members the ability to make informed decisions about self-care, medications, conditions, tests and treatments while facilitating communication with healthcare providers. The Healthwise Knowledgebase is available in English and Spanish.
Condition Centers – More than 35 in-depth condition centers are available, providing personalized resources to help the member address risk factors, manage existing chronic and acute conditions and explore how medical treatments and lifestyle modifications can lead to improved quality of life.
Personal Health Record – This feature provides a secure, confidential online location to store, manage and maintain a member’s self-reported health information. In addition to creating a complete, portable health profile that they can share with their physicians, members can check drug interactions and cross-reference easy-to-understand explanations of medical terms.
Health Assessment – Members can complete the health assessment to determine their personal health score and identify ways to lower health risks and track progress over time with a personalized health improvement program.
Secure Message Center and Personal Health News – Members can receive health-related secure messages with current news, drug alerts and health tips based on personal health interests and profiles. This personalized, objective and trustworthy information can help keep members informed of timely health subjects and medical developments that may matter to them.
Fitness – LEAP®, the Lifetime Exercise Adherence Program, is an online fitness management program created by an Olympic coach. Under the guidance of health and fitness professionals, LEAP helps members measure and manage their fitness.
A Host of Other Features – Members can also access women’s and men’s health centers, pregnancy and child health planners and a medical reference encyclopedia of health topics from A-Z.

PrecisionRx Specialty Solutions®

Resolution Health™, Inc.

Subimo™ Hospital Comparison Tool

Blue Cross and Blue Shield of Wyoming

BlueChoice High-Deductible Health Plans

To enable members to take charge of their health and assume more responsibility for how they spend their healthcare dollars, Blue Cross and Blue Shield of Wyoming offers BlueChoice High-Deductible Health Plans. When paired with Health Savings Accounts, these plans allow members to set aside pre-tax dollars for future medical expenses.

E-Library

Blue Cross and Blue Shield of Wyoming’s online health library gives members access to a range of health-related information, including news stories and a searchable index. Health Topic Centers also provide background on issues ranging from cerebral palsy to breast cancer and wound care.

Keeping Well

Keeping Well is the Blue Cross and Blue Shield of Wyoming newsletter. It delivers healthy lifestyle news and information to keep members up-to-date on the latest health trends and ways to cut healthcare costs. To access the most recent edition, please click here.

Specialty Pharmacy Programs

Blue Cross and Blue Shield of Wyoming (BCBSWY) members and eligible dependents are covered under the Specialty Pharmacy Drug Program. This program provides medications for members suffering from chronic diseases such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis, cystic fibrosis, cancer and hepatitis. It also offers counseling and medication expertise for these diseases. Among the advantages of using the Preferred Specialty Drug Provider:

The Preferred Specialty Drug Provider supplies injectable and oral specialty drugs at a reduced cost to BCBSWY. Since most benefit plans require that the member pay a percentage of the cost, this discounted rate should reduce members’ out-of-pocket expenses.
BCBSWY’s Preferred Specialty Drug Provider will only charge members for their financial responsibility and will bill BCBSWY for the balance. Participating pharmacists are also specially trained in chronic diseases and provide expert counseling on the use and side effects of various medications.
Utilizing the Preferred Specialty Drug Provider can afford members significant co-pay savings, as well as help preserve member benefits such as policy lifetime maximums, if applicable.

Upon selecting a Preferred Specialty Drug Provider, members receive:

Coordination of their medication coverage with BCBSWY;
Injection supplies (i.e., alcohol swabs, syringes, disposal containers, etc.) at no additional cost;
Around-the-clock access to pharmacists and nurses who specialize in these conditions and are able to answer questions about medications; and
Refill reminder calls.

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