Blue Cross Blue Shield of Delaware
Encourage Research on What Works
Technology Evaluation Center
Each of the 39 Blue Plans across the country, including Blue Cross Blue Shield of Delaware, 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®
Blue Cross Blue Shield of Delaware 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.
Continuity of Care Audit
Blue Cross Blue Shield of Delaware’s Quality Improvement nurses perform annual chart audits of primary care physicians to monitor the coordination of care and effective communication between hospitals or Ambulatory Surgery Centers and the patient’s PCP. Facilities that meet or fall below the average rates of information exchange are encouraged by BCBSD to review practices and develop steps to enhance communication in order to improve care coordination and patient outcomes. Care centers with a communication rate of 100 percent are asked to share best practices with lower-ranked facilities to ensure the effective exchange of patient information across the care continuum.
Empower Consumers and Providers
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.
Promote Health and Wellness
Blood Pressure Awareness
Blue Cross Blue Shield of Delaware launched the Blood Pressure Awareness initiative in June 2006 to encourage regular monitoring of individuals’ levels for improved health and wellness. State residents were able to check their blood pressure free of charge at a time and location convenient to them, and received a health tracker card with their results from the machines, located in ten public spaces throughout the state.
Since its implementation, more than 25,000 tests have been administered across the state, and 2,000 readings alerted residents of the need to visit a doctor for further consultation due to potentially-dangerous levels.
BluePrints for Health Diabetes Prevention
Blue Cross Blue Shield of Delaware developed the BluePrints for Health program to offer members a compendium of resources to make more-informed decisions about their health and improve overall wellness. The program encompasses four primary components — prevention and wellness, health education, care management and medical management — and provides Web-based information to promote health improvements for members, including:
- Delaware Blue – A quarterly member publication containing articles on health and wellness topics and updates on plan benefits and changes.
- Online Health and Wellness Tools
- Integrated Wellness Portal – Helps members reach personal health goals such as nutrition and fitness, smoking cessation and health coaching.
- My BlueConnection – Offers 24/7 access to the latest tips and information to maintain health and wellness.
- Hospital Comparison Tool – Allows members to search and compare hospitals around the United States on a number of performance factors, such as average length of stay, number of procedures performed and rates of complications and mortality.
- Pharmacy Tools – Helps members to manage prescription drug costs with estimated drug expenses and offers members access to adverse interaction tools to ensure prescribed medications work together without harmful side effects.
- Preventive Health Guidelines – Annually published guidelines with healthcare recommendations for every age, including a preventive care checklist of important tests, immunizations and screenings.
- Second Opinion Program – Provides members with independent second opinions for certain diagnoses, such as cancers and pediatric heart defects.
BMI Provider Outreach Initiative Diabetes Prevention
New Healthcare Effectiveness Data and Information Set (HEDIS) measures include the Body Mass Index (BMI) metric; however, many providers do not record BMI values in a patient’s medical record. To improve compliance, Blue Cross Blue Shield of Delaware has added BMI as one of the metrics within the medical record audits conducted at the time a provider is re-credentialed.
To assist providers in recording this data, Blue Cross Blue Shield of Delaware has developed and distributed BMI Wheels that provide a much quicker, easier method of calculating body mass than conventional charts.
HealthSmart Tips Diabetes Prevention
Blue Cross Blue Shield of Delaware partnered with the Medical Society of Delaware to launch a health and wellness advertising campaign called HealthSmart Tips, offering simple, everyday advice for staying healthy. Using print, radio, Web and billboard advertising, the program reminded people to get their blood pressure checked regularly and remain up to date on routine screenings such as vision exams. Additionally, the campaign encouraged compliance with doctors' orders and suggested keeping a personal health record. Through the program, the Plan also posted online tips on rotating banner advertisements on its website and offered advice on healthy grocery shopping, activities to challenge the brain and a basic fitness formula for improved wellness.
Foster Public-Private Coverage Solutions
BlueIndividual Plans
Blue Cross Blue Shield of Delaware (BCBSD) developed the BlueIndividual plans to provide residents ineligible for group coverage with access to affordable, comprehensive health insurance. The BlueIndividual portfolio offers three plan types, each compatible with a tax-advantaged health savings account (HSA) to allow flexibility in individuals’ healthcare cost management. Through the BCBSD website, consumers can compare the BlueIndividual plan options and use a personalized guide to select the product that best meets their needs.
