Blue Cross of Idaho
Encourage Research on What Works
Blue Health Intelligence
Blue Cross of Idaho 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.
Technology Evaluation Center
Each of the 39 Blue Plans across the country, including Blue Cross of Idaho, 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 of Idaho 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 Incentive Program
Blue Cross of Idaho partnered with the Idaho Hospital Association to launch the Hospital Quality Incentive Program, which measures patient safety and clinical outcomes and rewards participating facilities based on their performance. In addition to tracking rates of hospital-acquired infections and surgical complications, the initiative evaluates hospitals’ adherence to evidence-based measures known to improve health outcomes among patients with pneumonia, heart attack, congestive heart failure and diabetes. Providers that meet the program’s safety, quality and affordability goals receive financial incentives and are presented with the Hospital Quality Award at Blue Cross of Idaho’s annual Hospital Quality Conference.
Empower Consumers and Providers
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.
Promote Health and Wellness
Blue Cross of Idaho Foundation for Health, Inc.
Aiming to promote wellness and prevention statewide, Blue Cross of Idaho established the Blue Cross of Idaho Foundation for Health in 2001. The foundation supports initiatives that encourage healthy lifestyles, including educational outreach to elementary school children, a statewide smoking cessation project and an annual Blue Cruise Wheels for Wellness bike ride.
Disease Management Programs Diabetes Prevention
Blue Cross of Idaho developed a number of disease management programs to help members with chronic conditions such as asthma, congestive heart failure (CHF) and diabetes improve their overall health. Using a team of physicians and disease management nurses, the program helps ensure that members take the correct medications, test their blood sugar regularly and receive necessary screenings. Through one-on-one coaching and outreach efforts, the program generated a return on investment of roughly $3 in savings for each dollar spent. That success translates into more than $1.8 million in savings among CHF patients alone, driven by a five percent decrease in hospital readmission rates since the program’s inception.
Obesity Pilot Program Diabetes Prevention
Beginning in March 2007, Blue Cross of Idaho conducted a 12-month obesity pilot program that focused on fostering changes in the behavior of obese employees that would lead to healthier lifestyles through weight loss, improved health measures and an improved quality of life. Thirty people with body mass indexes (BMI) between 30 and 39.9 participated in the program. They were taught to eat nutritious foods and effectively exercise multiple times a week and were all assigned a health coach and personal trainer to support them throughout the program.
Ten of the 30 participants completed the 12-month program, and many of them rated their physical functioning, energy level, emotional well-being, pain level and general health significantly better at the end of the program. Eighty percent of these participants decreased their BMI. Participants also showed decreases in blood pressure, fasting glucose and weight loss.
Foster Public-Private Coverage Solutions
Chamber Blue Insurance Product
To provide a more affordable coverage option for small businesses, Blue Cross of Idaho developed the Chamber Blue product, a competitively priced, basic alternative to traditional group coverage. To be eligible for the plan, small businesses must be members of their local chamber of commerce and cannot have offered health coverage to their workers in the past 24 months. The plan provides benefits for major medical, preventive and wellness services and offers member savings of up to 20 percent compared with other products being offered in the marketplace.
