Physician and Cost Transparency

BlueCross BlueShield of Tennessee, Inc.

In the past, healthcare has been slow to respond to consumer needs for information and transparency, and BlueCross BlueShield of Tennessee, Inc. (BCBST) is changing that trend.

BCBST developed the Physician Quality and Cost Transparency program to guide consumers with their healthcare decisions. They phased in the program during a one-year period and then made the information available to all of BCBST's 1.3 million members. The available information includes HEDIS-based quality indicators associated with preventive and primary care. In the future, BCBST plans to include other items such as treatment of abnormal lipid levels, childhood immunizations and appropriate use of antibiotics.

Information is accessed on a Web-based tool through the online Provider Directory. Providers with rates 85 percent or more than one standard deviation above the state-wide average for that specialty and measure are shown as "above average" on graphic presentations. For those more than two standard deviations below, they are shown as "below average."

What sets this program apart from other similar efforts is the inclusive and collaborative way in which the program was organized. BCBST worked closely with a statewide physician panel, the Tennessee Department of Commerce and Insurance, state and county medical associations, business coalitions and provider groups. They also conducted patient focus groups and included a multi-step data validation process and review period that allowed providers to review their data and correct any inaccuracies. The program also incorporated a provider self-report function to increase the accuracy of the claims data, and used a nationally-recognized third-party vendor to remove perceptions of bias on the part of the Plan. The third-party vendor, Health Benchmarks, Inc., compiled and scored physician performance data for the program and performed a number of quality checks. Use of this vendor gave providers confidence in the accuracy of the data. The Web site experienced more than 10,000 hits in the first two weeks after wide publication of its availability.

Program Contact: Allen Naidoo, director, Medical Informatics, 423.535.3224, Allen_Naidoo@bcbst.com