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Anthem Blue Cross and Blue Shield (Kentucky)

Encourage Research on What Works

HealthCore®, Inc.

HealthCore, Inc., a subsidiary of Anthem Blue Cross and Blue Shield’s parent company, performs analytic research on clinical outcomes and comparative effectiveness.  HealthCore studies use clinical, laboratory and drug information to determine how therapies, treatments and pharmaceuticals work in the real world, outside of the compliance-guaranteed clinical trial environment.  HealthCore has also created the “Integrated Research Network™” (IRN™), working closely with academic medical centers, provider networks and local healthcare communities to rapidly disseminate information about clinical results and quickly transform clinical discoveries into improved care.  With more than 125 research studies underway, 30 completed studies published in professional journals and more than 150 completed studies presented at national medical meetings and seminars, HealthCore is helping to advance access to quality care through real-world outcomes research.

Technology Evaluation Center

Each of the 39 Blue Plans across the country, including Anthem Blue Cross and Blue Shield, has access to evidence-based healthcare technology assessments produced by the Blue Cross and Blue Shield Association’s Technology Evaluation Center (TEC).  Founded in 1985, TEC pioneered the development of scientific criteria for assessing the effectiveness of medical devices, procedures and biological products through comprehensive reviews of clinical evidence.  Averaging 15 to 20 assessments per year – each based on a synthesis of available evidence – TEC provides healthcare decision-makers with timely, objective and scientifically rigorous technology evaluations that inform coverage decisions, quality measures, educational materials, guidelines and research agendas.

The assessments performed by TEC – which is also one of 14 Evidence-based Practice Centers (EPCs) for the U.S. Agency for Healthcare Research and Quality – are based on objective clinical and scientific evidence and evaluate whether a technology improves health outcomes such as length of life, quality of life and ability to function.  TEC most recently has taken a national leadership role in the evaluation and analysis of evidence in the rapidly proliferating area of genetic testing and pharmacogenomics (i.e., how a person’s genetic make-up interacts with a drug’s effectiveness).

Change Incentives to Promote Better Care

Blue Distinction®

Anthem Blue Cross and Blue Shield is engaged in the Blue Cross and Blue Shield Association’s Blue Distinction® program – a designation awarded to medical facilities that have demonstrated expertise in delivering specialty care in one or more of the following areas: bariatric surgery, cardiac care, complex and rare cancers and transplants.  New Blue Distinction programs for spine surgery and knee and hip replacement will be introduced in 2009, and future designations are in preliminary stages of development.  The Blue Distinction designation is based on a facility’s ability to meet objective, evidence-based quality criteria established in collaboration with expert physicians and medical organizations.  Studies indicate Blue Distinction Centers® have better overall outcomes and lower costs for certain procedures when compared to non-designated medical facilities.

 

Today, more than 800 Blue Distinction designations have been awarded nationwide, helping consumers to find quality specialty care.  To locate a Blue Distinction Center, please visit the Blue Distinction Center Finder.

 

Hospital Quality Program

Anthem Blue Cross and Blue Shield crafted a hospital quality program to help reduce variation in practice patterns and outcomes among network hospitals.  The program has evolved to include an incentive payment for quality, electronic data submission and enhanced sharing of best practices.  Now called the Midwest Hospital Quality Improvement Program, it includes 357 hospitals in Ohio, Kentucky, Indiana and Missouri.  As part of the program:

  • An annual Request for Information (RFI) is sent to each network hospital.  The RFI consists of 10 core measures, developed in collaboration with participating hospitals, accrediting bodies and quality organizations.  Once the RFI is completed, data are entered into a confidential database, aggregated and analyzed.
  • Hospitals receive a report card with their overall score, as well as comparisons to their peer hospitals, matched by size for ease of comparison.  The Midwest Hospital Quality Improvement Program changes its measures in response to national and regional trends to incorporate more contemporary approaches for measuring or improving clinical quality.
  • Starting in 2003, incentives were paid to high-performing hospitals, while lower-performing hospitals were approached about remediation.  However, the goal of this program is not to punish lower-performing hospitals but to work with hospitals in a collaborative fashion to improve care quality.
  • Further collaboration is sparked by the annual Hospital Quality Program meetings.  Beginning in 2003, hospitals were asked to submit an abstract of a “successful practice,” which is judged by an impartial panel of Quality Improvement Directors from other regions.  Winning practices are presented at the Hospital Quality Improvement meetings, allowing for an exchange of ideas among competing hospitals.

Empower Consumers and Providers

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

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 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.

Promote Health and Wellness

360° Health® Diabetes Prevention

360° Health – a nationwide initiative spearheaded by Anthem Blue Cross and Blue Shield’s parent company – is a total health solution that gives people the tools they need to be better informed about and active in their health.  This fully integrated and member-centric approach to care encompasses more than 40 innovative products and services (360° Health product offering can vary by health plan purchased).  Product examples:

  • ComplexCare: Intense outreach and coordination from registered nurses specializing in managing the complex needs of members with multiple health conditions, as well as access to multidisciplinary teams and input
  • Future Moms: Support from trained obstetrical nurses in an award-winning maternity management program dedicated to helping expectant moms have a healthy pregnancy and delivery
  • 24/7 NurseLine: Anytime, toll-free access to registered nurses for answers to general health questions and guidance with critical health concerns
  • ConditionCare: Registered nurses who are committed to helping members with chronic conditions better manage and improve their health. Conditions include: asthma, diabetes, chronic obstructive pulmonary disease, coronary artery disease and heart failure.
  • MyHealth Advantage: Timely alerts in the mail called MyHealth Notes that notify members of possible gaps in care, issues with medications or ways to save money

Custom Care Connection Diabetes Prevention

Custom Care Connection (C3) is a care management program for Anthem Blue Cross and Blue Shield’s Medicare Advantage members.  It provides education and tools to assist senior members in managing their health and medical conditions and connects them with the local resources they need through regular contact with a C3 Nurse Care Manager.  The C3 Nurse Care Manager’s job is to educate and collaborate and set goals with members to help them make the best decisions about their healthcare while facilitating health behavior changes that fit in with the member’s unique lifestyle and needs.

Healthy Lifestyles Diabetes Prevention

Anthem Blue Cross and Blue Shield participates in the Healthy Lifestyles program, a comprehensive Web-based health and wellness program that encourages healthy behavior changes to help reduce costs and improve productivity.  Healthy Lifestyles works with members to set realistic health goals and create a personally tailored action plan focused on five key behaviors: exercise, weight management, nutrition, smoking cessation and stress management.  Some of the available self-directed tools and resources include:

  • Health Assessment and tracking tool to monitor health status, progress and improvement
  • Discounted access to alternative health providers and fitness center network
  • Smoking cessation program
  • Online coaching and access to health experts
  • Family (kids and teens) nutrition and exercise programs

Member participation and health improvement earns “points” redeemable for health and fitness merchandise and discounts.

MyHealth Advantage Diabetes Prevention

MyHealth Advantage is a component of 360° Health – a nationwide initiative spearheaded by Anthem Blue Cross and Blue Shield’s parent company – a total health solution that gives people the tools they need to be better informed about and active in their health. This fully integrated and member-centric approach to care encompasses more than 40 innovative products and services (360° Health product offering can vary by health plan purchased). MyHealth Advantage specifically offers timely member alerts in the mail called MyHealth Notes that notify members of possible gaps in care, issues with medications or ways to save money

The Member Health Index

The Member Health Index (MHI) represents Anthem’s commitment to its mission: “Improve the lives of our members and the health of the people we serve.”  Measured annually, the MHI is composed of 40 specific measures of health improvement and patient safety in 20 different clinical areas encompassing four domains of care: prevention, care management, clinical outcomes and patient safety.  The four domains of the MHI were specifically designed to encourage Plan leaders and associates to focus on improvement in areas that most directly affect member health.  Anthem’s care and disease management programs, hospital quality and safety programs and engagement strategies all converge in the MHI.  Success is measured by decreasing the “performance gap,” the difference between an optimal level of health and members’ current health status.  Achievement of MHI success is also linked to the incentive compensation plan of all associates.

Vascular-at-Risk Diabetes Prevention

The Vascular-at-Risk program developed by Anthem Blue Cross and Blue Shield targets hypertension, hyperlipidemia and metabolic syndrome – prevalent and potentially life-threatening conditions associated with an increased risk of coronary artery disease, diabetes, stroke, peripheral vascular disease and peripheral artery disease. Members diagnosed with one of these conditions receive tailored interventions through an Individualized Intervention Plan (IIP) that complements physicians’ prescribed plans of treatment. With proper coaching, health education and resources, the Vascular-at-Risk program works to improve the condition by empowering members to become better managers of their personal healthcare.

Foster Public-Private Coverage Solutions

Healthy Generations

Through a grant from Anthem Blue Cross and Blue Shield Foundation, LLC, the Plan is focusing on strategic initiatives that address and provide innovative solutions to help reduce the number of uninsured, as well as organizations and nonprofit charities that promote the Healthy Generations Program, a multi-generational initiative that targets specific disease states and medical conditions.  Specifically, Healthy Generations funds programs aimed at helping to improve several measures included in the State Health Index.  These measures include:

  • Increasing the percentage of mothers who engage in prenatal care during the first trimester of their pregnancies 
  • Decreasing the percentage of newborns who weigh less than 5.5 lbs 
  • Decreasing the coronary heart disease mortality rate 
  • Decreasing the prevalence of diagnosed diabetes in adults 
  • Increasing the percentage of the population who meet the CDC’s recommended levels of physical activity 
  • Decreasing the incidence of childhood obesity 
  • Decreasing the percentage of adults who smoke cigarettes
  • Increasing the percentage of adults over age 65 who receive an influenza vaccine
  • Increasing the percentage of adults over age 65 who receive a pneumococcal vaccine

Innovative and Affordable Benefit Designs

Anthem Blue Cross and Blue Shield has developed a portfolio of affordable individual and small group products aimed at helping to reduce the number of uninsured Kentucky residents.

  • NextRxSM Generic Plus One – Provides employers with a reliable pharmacy benefit with affordable, quality coverage for members of widely used brand-name medications.  The product covers all generically available medications and provides single-source branded products for highly utilized drug categories such as ADHD, arthritis, asthma, depression, diabetes, hypertension, insomnia and migraines.  Financial incentives shift employees from high-cost branded products to a lower-cost, clinically equivalent alternative, and mandatory mail-ordering further reduces costs.
  • Blue Access® Economy – Designed for those seeking a reliable coverage for themselves and their families.  The Blue Access Economy plan offers a compromise between the richer benefits of the Blue Access Plans and the more limited coverage of the Blue Access Value Plan.  Blue Access Economy, which allows members to choose from four deductibles ranging from $1,000 to $5,000, covers the first three office visits with a co-payment of $30 each.  Members can also select a variety of drug options offering different coverage levels, including generic-only coverage, brand-name coverage and mail-order service.