Blue Shield of California

Encourage Research on What Works

Technology Evaluation Center

Each of the 39 Blue Plans across the country, including Blue Shield of California, 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 Shield of California 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.

 

Generic Prescription Co-pay Reduction Program

To improve patients’ adherence to their medication regimens and lower prescription drug costs, Blue Shield of California developed the generic prescription co-pay reduction program.  Employer groups with more than 50 workers are eligible to participate in the program, which waives members’ co-pay on generic prescriptions and creates a financial incentive to switch from brand name therapies.

Pay-for-Performance Program

Blue Shield of California participates in a statewide pay-for-performance program that offers a uniform incentive structure for California physician groups and a publicly accessible scorecard on provider performance.  The initiative promotes high-quality, affordable healthcare by focusing on clinical performance, patient experience, health IT use and other criteria developed by the Integrated Healthcare Association (IHA).

For example, Blue Shield’s program uses the IHA standards to track physician groups’ performance on factors such as adolescent immunization rates, blood sugar monitoring for diabetics and the use of effective control medications for members with asthma.  In 2007, the Plan awarded more than $31 million in bonuses to medical groups across its network for implementing best practices to improve healthcare delivery and patient outcomes.

Promote Health and Wellness

Complex Care Management Diabetes Prevention

Blue Shield of California offers complex care management in an effort to provide more in-depth assistance to members with multiple health conditions. Through the program, healthcare professionals conduct onsite visits with members and help them take steps to manage their health. These services help ensure care coordination and appropriate resource use. 

Congestive Heart Failure Program

Blue Shield of California implemented the Congestive Heart Failure (CHF) Program to monitor patients suffering from CHF and improve their health outcomes.  Through the collaborative efforts of a team of physicians and nurses, the program provides coordinated, personalized care for members with CHF and tracks their progress using special home monitoring equipment.  Since its inception, the program has reduced expected inpatient admissions and emergency room visits by more than 20 percent among participating members.

Health Coach Diabetes Prevention

Health Coach is an employer-based program offered by Blue Shield of California that targets members at moderate and high risk for diabetes through a risk assessment and follow-up, telephonic coaching. The program proactively works with these members to address weight management, stress management, smoking cessation, nutrition and physical activity. Health Coach addresses modifiable behaviors with members through well-trained coaches with specialties in nutrition, education and exercise physiology.  Participants at high risk receive up to 12 scheduled calls, and those with moderate risk receive up to four calls; however, inbound calls to coaches are unlimited. Using a whole person coaching methodology, coaches tailor the coaching content to the participant’s needs and their readiness to change. 

Healthy Lifestyle Rewards Diabetes Prevention

Blue Shield of California developed the Healthy Lifestyle Rewards program to help members adopt and maintain healthy lifestyle habits such as good nutrition, stress management and regular exercise. Members begin the interactive, online program with a confidential Wellness Assessment to identify potentially harmful lifestyle habits.

Healthy Lifestyle Rewards offers five lifestyle improvement programs to support behavior change, plus many interactive tools to provide practical support.  The program customizes and personalizes a member’s experience so those at risk for diabetes are referred to the appropriate health programs, trackers and readings. Available tools and trackers to assist members in getting started and tracking progress include: recipes, a walking tracker, a diet tracker, a calorie calculator, a meal planner, a fitness planner, articles, tips and news.  Members can also draw upon peer support by accessing message boards to support their healthy choices (i.e. weight, nutrition), as well as message boards moderated by health experts that specifically address diabetes.

Foster Public-Private Coverage Solutions

The Blue Shield of California Foundation

Blue Shield of California’s charitable foundation, one of the largest private healthcare grant-making organizations in the state, is committed to creating a healthcare system that is effective, safe and accessible to all Californians. Among the foundation’s initiatives:

• Free Clinics – More than 170 community and free clinics statewide receive funding from the foundation, improving their ability to care for uninsured and underserved populations.
• Children’s Health Initiatives – The foundation has invested more than $18 million in programs to subsidize healthcare costs for 70,000 children in 19 counties.
• Local Coverage Expansion – The foundation supports innovative, community-based strategies for increasing coverage and improving access among uninsured and underserved populations.