Mountain State Blue Cross Blue Shield (West Virginia)

Encourage Research on What Works

Technology Evaluation Center

Each of the 39 Blue Plans across the country, including Mountain State Blue Cross & Blue Shield, 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®

Mountain State Blue Cross Blue Shield 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. 

Empower Consumers and Providers

Blues on Call®

Mountain State Blue Cross Blue Shield offers the Blues on Call program to help members access health information and become more involved in their care decisions.  With 24/7 telephone access to a certified health coach, members can ask questions about recent diagnoses, upcoming tests and procedures or general health topics.  An integrated disease management program also supports members with diabetes, cardiac conditions, asthma and other illnesses, aiming to address each patient’s total healthcare needs.

In addition, the Plan’s website offers access to the Blues on Call program and enables members to research health topics or communicate with a health coach online.  Through the Blues on Call website, members can access the latest information on nationally endorsed care guidelines and evidence-based practices to ensure that they are adhering to self-management recommendations.

Finally, the Healthwise Knowledgebase offers members decision support resources that can help determine when a problem can be treated at home, when to see a doctor and what treatment option best suits the patient’s needs.  The resources include a library of health topics, information on various tests and procedures and interactive tools to help members better manage their personal health.

My Benefits Home

Through an online portal known as My Benefits Home, Mountain State Blue Cross Blue Shield offers members a variety of Web-based tools designed to help them take control of their healthcare decisions and lead healthier lives.  Among them:

• Coverage Advisor – Provides detailed information about medical and drug benefit levels and offers a Plan Cost Advisor for estimating overall and out-of-pocket expenses
• Expense Advisor – Allows members to track medical and pharmacy claims, access cost information for certain procedures and treatments and view detailed information on health savings, health reimbursement or flexible spending accounts
• Personal Health Advisor – Helps members track their medical history, assess their personal wellness and develop an improvement plan.  For example, members have around-the-clock access to a health coach who can help them explore treatment options.  They can also use a health risk assessment tool to prioritize lifestyle changes, find online information on preventive care and consolidate their health information in a personal health record.  Finally, the portal enables them to view their medication history, order prescription drugs and check the status of medication requests.
• Healthcare Provider Comparison – Allows members to locate a nearby pharmacy, access provider quality data and search a network of physicians, hospitals and other providers based on designated criteria
• Health Topic Library – Enables members to use a Health Encyclopedia to learn more about diseases and conditions, receive updated information on surgeries and procedures, search for articles on family health topics and obtain tips on making healthy lifestyle choices.  The Chronic Condition Guide also helps members with asthma, allergies, high cholesterol and other chronic conditions learn techniques for controlling their illness.

NaviNet Information Portal

In an effort to reduce administrative burden and improve care coordination, Mountain State Blue Cross Blue Shield developed the NaviNet online portal, which offers network providers and facilities real-time access to information about patients’ eligibility, benefits, claims status and other transactions.  The secure online program allows physicians and other providers to calculate patient responsibility for out-of-pocket expenses, review claims submissions and search for diagnosis codes by number or condition from any computer connected to the Internet.

Promote Health and Wellness

Challenge for Healthier Schools Diabetes Prevention Childhood Obesity Prevention

In conjunction with the West Virginia Department of Education, Mountain State Blue Cross Blue Shield created the Challenge for Healthier Schools program to help fund innovative initiatives promoting increased physical activity and nutrition education among elementary school students.  The program encourages teachers, students and parents to collaborate in developing a complete approach to student wellness, instilling healthy lifestyle habits at a young age and positively impacting children’s long-term health.

In addition, the Plan has distributed $150,000 in grants to initiatives that promote appropriate school lunches and vending machine offerings, as well as opportunities for all students to participate in physical fitness activities in a non-competitive environment.

Dr. Dean Ornish Program for Reversing Heart Disease

Mountain State Blue Cross Blue Shield offers the Dr. Dean Ornish Program in an effort to coordinate preventive and primary care for patients with heart disease and promote healthy lifestyle habits that can slow, stop and reverse the damage caused by the chronic condition.  The program is divided into two versions:

• The Reversal Model – Designed for individuals with known heart disease or who are at high risk of developing heart disease or diabetes
• Ornish Advantage – Intended for individuals who are at risk of developing heart disease and are seeking to prevent it

The program has resulted in significant improvements, with 78 percent of participants avoiding bypass surgery or angioplasty procedures.  Participants also experienced statistically significant reductions in all risk categories, including angina, blood pressure, cholesterol levels, weight and body fat.  Additionally, a 2003 cost analysis estimated that program participation saved an average of more than $17,000 per patient from avoided invasive procedures, heart attacks, medication use and cardiac rehabilitation.

HealthPlace on the Move Diabetes Prevention

To raise awareness of health risks and provide preventive care, Mountain State Blue Cross Blue Shield created the HealthPlace on the Move program, which operates out of a mobile health screening facility.  The HealthPlace on the Move bus visits community events to provide basic health screenings, including blood pressure readings, body composition assessments and cholesterol and blood glucose tests.  A team of healthcare professionals also distributes health information to reinforce the importance of personal wellness and offer tips on adopting healthy lifestyle habits.

Lifestyle Returns Program Diabetes Prevention

To encourage members to improve their personal health, Mountain State Blue Cross Blue Shield launched the Lifestyle Returns program, which rewards employees for participating in wellness initiatives and seeking preventive care.  Initially, members complete a health risk assessment to gauge their wellness and identify problem areas.  Lifestyle Returns then connects them with programs and resources designed to improve their personal health.  Reminders of gender- and age-specific preventive screenings, for example, help ensure that members receive recommended care.  In return for taking steps to improve their health, members are rewarded with financial reimbursements, decreased employee premium contributions and increased benefit levels.

Uninsured and Low-Income Flu Vaccinations

To expand access to flu shots among uninsured and low-income populations, Mountain State Blue Cross Blue Shield donated 500 vaccines to two free clinics in the state.  Annual adult flu vaccines not only benefit recipients’ health but can also result in substantial cost savings for the healthcare system.

Foster Public-Private Coverage Solutions

West Virginia Small Business Plan

Mountain State Blue Cross Blue Shield (MSBCBS) partnered with the state’s Public Employees Insurance Agency (PEIA) to offer the Small Business Plan, a comprehensive, affordable health coverage product for businesses with less than 51 employees. The Small Business Plan uses PEIA’s negotiated rates with providers and pharmacies, and MSBCBS offers discounts on one of its high-deductible PPOs, reducing administrative fees and premiums by 17 percent to 22 percent.  As of June 2008, the Small Business Plan had 1,071 contracts covering 1,711 members.