April 18, 2014

BlueCross BlueShield of South Carolina (BCBSSC), like many health insurers, struggled with an ever-increasing volume of patient information. It needed to find a way to normalize its vast quantities of data and help employers learn more about policyholders so they may improve healthcare offerings.

“As you get more sources of data from more programs, the question is: How do you aggregate the data and normalize it to give you a true indication of the program and the improvement of someone’s health?” Matt Shaffer, BlueCross major group SVP, tells I&T.

BCBSSC had several requirements for a data management solution. The insurer wanted to provide one data source across multiple platforms, be able to add new data as it became available, and normalize that data so it could be evaluated. It selected a product from software development company Health Data & Management Solutions (HDMS), the Blue DataConnect health services program, to analyze health and pharmacy claim information.

When policyholders begin to conduct personal health assessments and participate in biometric screenings or online wellness programs, the data they create is not claims data, explains Shaffer. Employers want to combine all of their patients’ health data and activity then compare it to their underlying health cost so as to better understand the effectiveness of their wellness programs.

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“As the industry expands the number of programs and offerings to get at health improvement and population health management, it creates new challenges for demonstrating the effectiveness of those programs,” he says.

BCBSSC chose the Blue DataConnect health services program to improve data insight for its customers. The implementation process began in June 2012 with the goal of a January 2013 completion. The timeline was aggressive, says Shaffer, but the system was implemented and launched by December 2012.

The BlueCross staff collaborated with HDMS to improve the system’s reporting functions by including case management, disease management and lifestyle management capabilities in addition to wellness data. With these additional data sources, large group customers can better perform wellness program selection, strategic planning and benefits selection. BCBSSC expanded the tool after its launch to include data on preventative and lifestyle measures.

“This is the first time that we’ve been able to bring all of the data collection, analysis and reporting together in one platform,” Shaffer says in a release. “We can now give a more comprehensive and accurate look at an employer’s health plan, the health of its population and the effectiveness of its disease management and other programs.”

The system has assisted employers with patient data management. Employers can see how wellness programs were administered and understand when biometric screenings and personal health assessments were conducted, when people began wellness programs and when they received calls from health coaches.

BCBSSC has increased internal efficiencies by having one platform to pull reports from rather than trying to aggregate multiple platforms, Shaffer explains. The system shows how many people participated in one or more wellness programs and indicates their risk movement over time according to age, gender and relationship.

Based on the data provided by Blue DataConnect, BCBSSC customers can improve their communications strategies and develop incentives for employees with poor health habits. If, for example, a customer notices that a diabetic employee is not taking their expensive medication, they may choose to offer an incentive – such as a prescription waiver – to help them better manage their condition. The solution will help employers that want to reach people who are struggling with their conditions and aren’t taking advantage of wellness programs.

Even with the new system, aggregating large amounts of information is a challenge, Shaffer admits. “It really is taking salt water and trying to make drinking water from it," he says. “There are a lot of uses for the data, and we find new uses every day.” As employers implement more programs, he says, BCBSSC has become more adept at integrating data sources to build improved risk profiles.

BCBSSC was recently recognized by HDMS for its use of Blue DataConnect. The insurer was presented with the Health Plan Innovator Award for Transformation of Analytics at the HDMS User Forum this month in Puerto Rico.

ABOUT THE AUTHOR
Kelly is an associate editor for Insurance & Technology. Prior to joining InformationWeek Financial Services, she was a staff writer for InformationWeek and InformationWeek Education. Kelly has also written for trade ...