Wellmark Blue Cross and Blue Shield of Iowa
Encourage Research on What Works
Technology Evaluation Center
Each of the 39 Blue Plans across the country, including Wellmark Blue Cross and Blue Shield of Iowa, 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®
Wellmark Blue Cross and Blue Shield of Iowa 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.
Incent and Reward Best Practices Program
Wellmark Blue Cross and Blue Shield of Iowa’s Incent and Reward Best Practices program rewards physicians who demonstrate a commitment to providing diabetes care and patient education that aligns with national standards and other care quality measures. Clinicians who meet clinical performance and patient outcome targets are eligible to receive special recognition and potential financial rewards from the Plan. Participating providers also agree to share their performance information with members, employers and other clinicians, and starting in the second quarter of 2008, clinic-level performance data for primary care physicians was posted online.
Patient-Centered Medical Homes
Wellmark Blue Cross and Blue Shield of Iowa’s patient-centered medical home (PCMH) demonstration project, which is currently in progress, aims to promote patient-physician collaboration and care coordination by explaining the role of specialists, suggesting appropriate and compassionate treatment options and answering patients’ questions about illnesses. The PCMH encompasses care for all stages of life, including acute and chronic care, preventive services and end-of-life care. The model also empowers consumers to access healthcare options appropriate to their situation and make healthier lifestyle choices.
Empower Consumers and Providers
Blue Priority HSA
Wellmark Blue Cross and Blue Shield of Iowa’s Blue Priority Health Savings Account (HSA) products for small employers and individuals combine a high-deductible health plan with an HSA, providing affordable coverage while allowing consumers to take more control of their healthcare dollars. Blue Priority also offers a health reimbursement arrangement to large employers that can be paired with any type of plan with a deductible of more than $1,000.
Health Information Technology
To help members make informed healthcare decisions, Wellmark Blue Cross and Blue Shield of Iowa supports efforts to bolster the use of health IT resources. For example, the Plan offers around-the-clock nurse triage and decision-support services, customized worksite wellness programs, personal health assessments and chronic disease and specialty condition management programs. Wellmark also helps physicians deliver the right care at the right time by giving them access to fully integrated electronic personal health records.
Telemedicine Programs
To ensure that members have access to the highest-quality care available, Wellmark Blue Cross and Blue Shield of Iowa helps fund programs that connect residents in rural areas with specialists across the state. Using a secure electronic platform to deliver telemedicine services, the programs focus on improving the health of Iowa residents through diabetes management, depression treatment and health literacy education.
Promote Health and Wellness
Collaborating for Innovative Care (CIC) Learning Collaborative Diabetes Prevention
Wellmark Blue Cross and Blue Shield of Iowa’s Collaborating for Innovative Care (CIC) Learning Collaborative, a series of learning sessions and personalized resources for primary care practices in the Wellmark network, aims to help care teams improve the quality of diabetes care through process improvement and disease management techniques. The Learning Collaborative stresses teamwork and electronic data as ways to improve provider performance. Participants are coached on the Wagner Chronic Care model, which is based on evidence-based guidelines and new concepts in clinical office practice. Participants also utilize a data collection tool that allows them to access clinical information and administrative claims data, identify improvement opportunities in their practice and monitor progress.
The CIC Learning Collaborative is just one of the initiatives introduced by Wellmark in the past several years under the Collaboration on Quality program. This suite of initiatives is focused on providing information, incentives and support to Wellmark’s participating clinicians and facilities so that they can improve their quality of care.
National Walk@Lunch Day Diabetes Prevention
Wellmark Blue Cross and Blue Shield of Iowa participates in National Walk@Lunch Day, which encourages members to walk during their lunch break. Given that most people's schedules are built around the workday, National Walk@Lunch Day is designed to fit into – not compete with – the structure of their daily routine. Through its participation in the initiative, the Plan aims to raise awareness of the value of regular physical activity.
