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Blue Cross Blue Shield of Michigan

Encourage Research on What Works

BCBSM Foundation

The BCBSM Foundation, the philanthropic affiliate of Blue Cross Blue Shield of Michigan, focuses on developing and funding research and program initiatives related to quality improvement, cost reduction and access to care for the uninsured.  The BCBSM Foundation reports the results of the projects it supports to the public, works with Blue Cross Blue Shield of Michigan to implement research findings and communicates results to consumers, providers and policymakers.  To learn more about the BCBSM Foundation and its activities, please visit http://www.bcbsm.com/foundation/.

Blue Health Intelligence

Blue Cross Blue Shield of Michigan 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 more than 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.

Center for Healthcare Research & Transformation

Blue Cross Blue Shield of Michigan partnered with the University of Michigan Health System to launch the Center for Healthcare Research & Transformation, a think tank for developing and testing new ideas to improve the effectiveness and efficiency of healthcare.  Four demonstration projects are currently underway:

  • Focus on Diabetes is designed to evaluate the impact of reduced medication co-pays on healthcare utilization and expenditures for individuals with diabetes.
  • Encouraging Appropriate and Judicious Use of Cardiac Services is a project designed to improve quality of care and achieve cost savings by increasing patient involvement in treatment decision-making and reducing variation in diagnostic and therapeutic services for patients with stable coronary artery disease.
  • Encouraging Appropriate and Judicious Use of High Technology Radiology for Low Back Pain is a project designed to improve health outcomes for patients with low back pain and avoid the excess cost and potentially negative patient outcomes associated with overutilization of high technology scanning.
  • Patient-Centered Medical Homes (PCMH) will assess the current status of PCMH in Michigan and evaluate the impact of PCMH elements, such as expanded access to care and coordination of care efforts, on the delivery of cost-effective, high quality care and the development of a sustainable reimbursement model.

Technology Evaluation Center

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

BCN’s Healthy Blue Living

BCN's Healthy Blue Living was first-to-market in Michigan and the nation with a product structure that encourages employees and their spouses to commit to healthy lifestyles, supported by their primary care physicians and the Blue Care Network (BCN).  The rewards for that commitment - in addition to achieving better health - are lower co-payments and deductibles for members.  The target for savings for employers is an average 10 percent reduction compared with an HMO product without the unique structure.

Members with this coverage have access to care management programs and services.  These include free smoking cessation and weight loss programs, free award-winning health education programs and BCN's disease management programs, which assist members with chronic conditions.  Experienced health coaches also are available to work with at-risk members on an individual basis to help them manage specific health issues.

Blue Distinction®

Blue Cross Blue Shield of Michigan 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. 

Healthy Blue Incentives Program

Blue Cross Blue Shield of Michigan's Healthy Blue Incentives is a PPO product that reduces co-payments and deductibles for members who participate in its wellness program.  After enrolling in Healthy Blue Incentives, members complete a health risk appraisal to identify risk factors such as tobacco use, high body mass index or high blood pressure.  Those with a high risk profile are referred to a health coach to develop a wellness action plan.

Through regular contact with the personal health coach and participation in a tailored wellness program, members become eligible for reduced co-pays and lower deductibles and maintain those enhanced benefit levels by continuing with their wellness program and demonstrating progress toward their health goals.  Additionally, employers are rewarded for their workers' wellness with up to 10 percent cost savings, incentivizing health promotion in the workplace.

Patient-Centered Medical Homes

Partnering with and providing incentives to physician organizations, Blue Cross Blue Shield of Michigan (BCBSM) implemented initiative frameworks to guide the difficult work to re-tool practices so that they can function as patient-centered medical homes (PCMHs).  PCMHs are intended to transform the care delivery model and promote quality, efficiency and coordination.  Clinical teams at PCMHs manage patients' healthcare needs, work with members to identify personal health goals and coordinate care provided by specialists and healthcare facilities.  BCBSM uses its Physician Group Incentive Program (PGIP) to catalyze physician organizations to reorganize their clinical practices to conform to the PCMH model of care delivery.  In 2008, roughly $30 million of the $50 million expected to be distributed by the PGIP will go to physician organizations that are assisting practices to implement the PCMH approach.

Save Lives Save Dollars Initiative

Blue Cross Blue Shield of Michigan participates in the Greater Detroit Area Health Council's (GDAHC) multi-stakeholder Save Lives Save Dollars (SLSD) initiative, which aims to drive quality improvement and achieve cost reductions across southeastern Michigan.  Focusing on coordinated, intermediate and long-term actions, the initiative promotes adherence to evidence-based guidelines and performance metrics for diabetes care, the prevention of surgical site infections and generic drug utilization, as well as heart attack, heart failure and pneumonia care.  SLSD is also involved in the Robert Wood Johnson's Regional Quality Strategy, "Aligning Forces for Quality," as well as efforts to reduce health disparities, promote appropriate ER use and better manage patients' back pain.  The SLSD website is now posting performance information on SE Michigan hospitals, health plans and physician organizations.

Value Partnerships Incentive Programs

Working closely with physician organizations and hospitals, Blue Cross Blue Shield of Michigan launched the Value Partnerships Incentive Programs, which are designed to improve care quality and reduce costs.  These pay-for-performance initiatives foster collaboration among various stakeholders, contributing to the development of a highly functioning, quality-based healthcare system.  They include:

  • Physician Group Incentive Program – Offers physician organizations financial incentives to focus on both long-term improvements in systems of care and short-term savings opportunities. PGIP mobilizes physician organizations via an array of initiatives that are focused on areas such as improving pharmacy or radiology cost and use, increasing adherence to evidence-based medicine standards for chronic disease or implementing capabilities that are needed to equip practices to function as patient-centered medical homes.
  • Hospital Pay-for-Performance Programs – Provide financial incentives for mid-size and large acute care hospitals, as well as rural facilities, participating in BCBSM Collaborative Quality Initiatives, which promote high-quality, efficient and affordable patient care 

Empower Consumers and Providers

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

     

    Promote Health and Wellness

    BlueHealthConnection® Wellness and Care Management Diabetes Prevention

    Blue Cross Blue Shield of Michigan's (BCBSM) BlueHealthConnection integrated wellness and care management program offers a wide range of services from lifestyle risk assessment to complex case management. BlueHealthConnection's core components include an e-Health portal, 24/7 Nurse Call Line, Quit the Nic smoking cessation, chronic disease management, preference-sensitive condition management, case management and affinity programs and reporting. BlueHealthConnection's e-Health portal offers a variety of online tools, including an online health risk assessment; an online health coach; a searchable database of diseases and conditions; a searchable database of drug information and potential interactions; and health newsletters.

    BlueHealthConnection also has targeted intervention components for specific conditions that fall in two categories: chronic disease and preference-sensitive condition management. In addition to diabetes, identification and intervention programs are in place for the following conditions: asthma, back pain, benign prostatic hypertrophy, benign uterine conditions, depression (screening for all cases), cancer, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, joint pain (hip and knee) and revascularization. Through a unique consultative approach, BCBSM offers the ability to "tailor" the package of BlueHealthConnection components. This solution-based approach delivers a combination of wellness and care management components that match a client's goals and objectives.

    Since 2003, BHC has delivered significant results. Among them:

    • Member satisfaction rates consistently above 90 percent
    • Substantial improvements in clinical quality measures for diabetes management, including a five percentage-point increase in rates of kidney disease monitoring and a 3.8 percent increase in the use of two or more hemoglobin A1c tests
    • An overall 2:1 return on the investment made in the program, saving an average of over $30 million in benefit costs each year

     

    Childhood Obesity Prevention Initiative Diabetes Prevention Childhood Obesity Prevention

    Blue Cross Blue Shield of Michigan worked with healthcare professionals to develop the Pediatric Healthy Weight Toolkit, a resource for physicians to identify overweight and obese children and counsel families on the health risks associated with obesity.  Each toolkit contains approximately 20 pages of materials, including:

    • Age-specific body mass index (BMI) charts
    • Risk assessments of a child’s likelihood of becoming obese
    • Treatment recommendations for overweight and obese children
    • Techniques for effective communication with families
    • Resources for identifying and managing type 2 diabetes and hypertension in children


    Additionally, the childhood obesity prevention initiative offers grants to community- and school-based programs that encourage physical activity and good nutrition. These initiatives aim to reduce the incidence of childhood obesity and instill healthy lifestyle habits in youth statewide.

    Quit the Nic Smoking Cessation Program

    Blue Cross Blue Shield of Michigan’s Quit the Nic program encourages members to discontinue tobacco use and guides them through the smoking cessation process.  As part of the broader BlueHealthConnection (BHC) initiative, an integrated wellness and care management program, members have access to a 24-hour nurse hotline that they can call to request educational materials and discuss their smoking cessation efforts with a registered nurse.  During the telephone call, a BHC health coach may discuss the member’s readiness to quit, help develop an action plan and establish a formal quit date.  The nurse also keeps in regular contact with the member to offer ongoing encouragement, answer questions that arise during the process and evaluate progress toward full smoking cessation.

    WalkingWorks Program Diabetes Prevention

    Blue Cross Blue Shield of Michigan’s WalkingWorks program encourages members to find opportunities to walk more every day and provides resources and tools for tracking their progress.  WalkingWorks also provides a comprehensive set of materials available on CD-ROM to help members launch worksite walking programs.  The program is designed to raise awareness of the health risks posed by an inactive lifestyle and demonstrate the value of simply walking at a brisk pace, an activity that has been shown to reduce heart disease and diabetes risks and help control weight, improve muscle tone and enhance wellness.

    Foster Public-Private Coverage Solutions

    MIChild Program

    Blue Cross Blue Shield of Michigan (BCBSM) is committed to providing health coverage to children through its participation in MIChild, Michigan's State Children's Health Insurance Program. Through the MIChild program, which is administered by the Michigan Department of Community Health, children in eligible families receive comprehensive medical and dental coverage for only $10 per month. The program covers a range of services, including oral exams and dental checkups, emergency care, hospital treatment, prescription drugs, well-baby care, health exams, vaccinations and vision and hearing care.

    Following a significant reduction in the state's outreach budget that limited its ability to market the program, BCBSM partnered with the state and implemented multiple strategies to increase MIChild enrollment. To achieve this goal, the Plan has an ongoing dialogue with state staff at all levels of the campaign. In addition, BCBSM fosters relationships within the community; pools corporate resources in its Government Affairs, Marketing, Media Relations and Community Affairs departments; and leverages the talents and goodwill of its diverse workforce to strengthen outreach efforts.