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Blue Cross and Blue Shield of Alabama

Encourage Research on What Works

Blue Health Intelligence

Blue Cross and Blue Shield of Alabama participates in the Blue Cross and Blue Shield Association's Blue Health Intelligence (BHI) program, which ranks as the nation's largest, HIPAA-compliant, multi-Plan database and brings together de-identified data on the claims experience of over 50 million Blue Cross and Blue Shield members nationwide. Blue Cross and Blue Shield Plans use BHI - the broadest, deepest pool of claims information ever created - as a tool to assist in understanding healthcare trends, cost drivers and other important factors related to healthcare delivery. This data analysis allows the Plan and employer accounts to proactively design products to meet identified needs and provide higher-quality care to their members. For example, high rates of cardiac disease could trigger targeted wellness initiatives.

As BHI expands, it will have the potential to provide policymakers and healthcare stakeholders with a steady flow of data, giving physicians and hospitals powerful insight into the appropriateness and effectiveness of emerging medical trends and treatment options. The data warehouse will also help identify high-performing physicians and hospitals; strengthen the momentum toward greater healthcare transparency; create opportunities for health services research and give policymakers information on drug safety, drug efficacy, disease spread and the impact of new technologies and procedures.

Technology Evaluation Center

Each of the 39 Blue Plans across the country, including Blue Cross and Blue Shield of Alabama, 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

Alabama Health Improvement Initiative

Blue Cross and Blue Shield of Alabama partnered with healthcare providers and employers statewide to establish the Alabama Health Improvement Initiative (AHII), a collaborative approach to rewarding physicians who deliver high-quality care.  The first phase of the program, which focuses on diabetes care, rewards general and specialty physicians identified through the National Committee for Quality Assurance's (NCQA) Diabetes Physician Recognition Program.  Later phases of the program will recognize superior performance among physicians in other care areas.  After receiving NCQA recognition, each qualified physician is publicly recognized, receives a $1,500 recognition reward and becomes eligible for annual incentives of up to $20,000 per year or a maximum of $50,000 over a three-year period.

Alabama Hospital Quality Initiative

Blue Cross and Blue Shield of Alabama launched the Alabama Hospital Quality Initiative (AHQI) to reduce hospital-acquired infections (HAIs) and promote appropriate antibiotic use.  HAIs affect an estimated 90 million lives each year, or nearly six percent of admitted patients.  In collaboration with the Alabama Hospital Association and a key vendor, hospitals are able to identify potential real-time warning signs of an infection outbreak, track and quantify nosocomial infection trends, share best practices and evaluate the effectiveness of infection control interventions.  AHQI promotes nursing unit-level goal setting to reduce infections, defines and standardizes best practices statewide and enhances transparency through timely, electronically transmitted hospital data regarding different and specific sources of infection and corresponding strains' susceptibility to antibiotics.  The statewide initiative positively influences care from the hospital board to bedside nursing care.  Among the program's results:

  • 100 percent of Alabama hospitals participate in AHQI.
  • Since 2004, HAIs have fallen by 25-30 percent.
  • Peer-to-peer hospital transparency, which promotes the dissemination of best practices, is an important element of this quality initiative.

Blue Distinction®

Blue Cross and Blue Shield of Alabama 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 Tiered Network

Jan. 1, 2009, marked the beginning of the fourth year of Blue Cross and Blue Shield of Alabama's Hospital Tiered Network.  The network was launched in response to healthcare consumers' request for a network that focuses on both cost and quality.  Hospitals receive a tier ranking based on three primary components, including fiscal, quality and patient safety performance.  The Hospital Tiered Network has provided a way to encourage and reinforce improvements in healthcare transparency and quality. Among the most recent successes:

  • Prior to July 1, 2006, there were 35 (or 34 percent of) hospitals in the state utilizing a rapid response team (RRT).  In 2008, 93 (or 92 percent of) facilities have confirmed the implementation of the RRT methodology.  An RRT is a group assembled by each healthcare facility that responds immediately to patients who exhibit signs of cardiac arrest.  RRTs' goal is to reduce the number of cardiac arrests that take place outside of the ICU.
  • In 2007, hospitals were asked to have employees complete a version of the Agency for Healthcare Research and Quality (AHRQ) Employee Culture of Safety Survey, which enables hospital employees to provide anonymous feedback to management about the perceived culture of safety at their facility.  As a result, 98 hospitals participated, and over 18,000 surveys were entered.  These data helped identify medication reconciliation and patient hand-offs as potential areas for statewide improvement.
  • The 2008 Tiered Network Criteria asked hospitals to enroll in the Institute for Healthcare Improvement's (IHI) 5 Million Lives Campaign.  The national campaign aims to reduce the incidence of preventable patient harm.  In 2006, 38 (or 37 percent of) state hospitals were enrolled in the campaign.  As of 2008, 94 (or 93 percent of) hospitals have confirmed enrollment in the campaign and are listed on the IHI website.  For 2009, hospitals have been asked to increase their level of engagement in the campaign.

Empower Consumers and Providers

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.

Promote Health and Wellness

Baby YourselfSM

The goal of Blue Cross and Blue Shield of Alabama's Baby Yourself prenatal wellness program is to ensure a healthy pregnancy and provide the best chance for a healthy baby.  Participants can enroll once they learn they are pregnant and receive telephone-based support from a nurse throughout their pregnancy.

 

BeHealthy.com Diabetes Prevention

A comprehensive health website powered by WebMD®, BeHealthy.com provides Blue Cross and Blue Shield of Alabama members with up-to-date information about illnesses, conditions and the latest health news.  Members also get access to health trackers, calculators and assessments, and they can personalize the site to fit their needs.  Among the available resources:

  • HealthQuotientTM (HQ) - After taking this health assessment, members get an immediate, personalized online report showing an overview of their current health status and ways to reduce health risks.  In 2007, the Plan logged 13,799 HQ completions; in 2008, that number grew to 21,694.
  • LifeStyle Solutions - These six-week, Web-based health courses offer step-by-step assistance to help members change unhealthy behaviors and make better health choices.  Participants can choose one of 14 courses or engage in the program personally recommended for them by the HealthQuotient.
  • Personal Health Record (PHR) - The PHR allows members to keep all their health information in one secure, centralized location.  Information can be entered manually, and members can choose for data to be automatically added from two years of processed claims. Members may also choose to share their PHR with their providers.
  • Blue 365SM - This program offers discounts and savings from selected companies on products and services for a healthy lifestyle.  Areas where members can find savings include weight loss programs, fitness programs and other health-related services that address members' unique needs.
  • Interactive Web Tools - Members have access to health trackers, the latest health news, a symptom checker, a treatment cost estimator and an Rx Benefit Manager. Members also have access to online message boards, which are expert-moderated and cover a wide variety of health topics.

For Your Health® Disease Management Diabetes Prevention

Blue Cross and Blue Shield of Alabama's disease management programs measurably improve lives by offering a fully integrated suite of clinical and administrative services that span the entire health continuum. Interventions are tailored to support and maintain health and prevent any decline that may lead to future health risks. Five core programs available to members focus on asthma, coronary artery disease, chronic obstructive pulmonary disease, heart failure and diabetes.

Worksite Wellness Programs Diabetes Prevention

Blue Cross and Blue Shield of Alabama helps employers plan and deliver effective wellness programs by tailoring wellness services to meet their needs. The Plan's suite of worksite wellness programs includes:

Foster Public-Private Coverage Solutions

The Alabama Child Caring Program

Blue Cross and Blue Shield of Alabama established the Alabama Child Caring Program (ACCP) in 1988 to provide immediate care and ongoing coverage to uninsured children up to age 18 who are ineligible for state programs.  ACCP covers primary and preventive healthcare and a comprehensive range of outpatient services, including:

  • Periodic well-child physical examinations
  • Physician office visits for illness or injury
  • Routine immunizations
  • Emergency care
  • Hospital outpatient care, including outpatient surgery and diagnostic lab, X-ray and pathology services
  • Vision care

Since the first child was enrolled in March 1988, ACCP has provided coverage to more than 69,000 children, helping Alabama to lead the nation with the lowest percentage of medically-uninsured children.  Currently, more than 7,500 children are enrolled in the program, and 2,300 more are on the waiting list.