Blue Cross and Blue Shield Companies Address Pharmaceutical Challenges To Improve Healthcare Quality And Affordability
Three Programs Earn BlueWorks Recognition From Harvard Medical School Researchers
An estimated 6.2 million Americans misuse prescription drugs. In 2003, legal drugs were responsible for almost three times as many deaths as illegal narcotics, even when suicides were not counted.
The Blue Cross and Blue Shield Association (BCBSA) and Harvard Medical School's Department of Healthcare Policy today recognized a unique program developed by Anthem Blue Cross and Blue Shield to help address this problem. The recognition came as part of BCBSA's BlueWorks program, a collaboration between BCBSA and Harvard that identifies successful programs across the nation that are helping to keep healthcare affordable and improve the quality of care.
Anthem Blue Cross and Blue Shield, in partnership with Anthem Prescription Management, designed a program to help physicians and other healthcare professionals identify patients' questionable narcotic drug use patterns. Anthem BCBS's clinical pharmacy staff identified a specific pattern of pharmacy claims among members, potentially indicating misuse or overmedication with narcotic prescriptions. It can be described as a "Rule of Three": three or more narcotic prescriptions written by three or more physicians and filled at three or more pharmacies within a three-month period.
When members with claims that fit these criteria are identified, prescribing physicians receive educational mailings that outline the initiative and offer pain management guidelines. A key component of the mailing is a member-specific profile that gives each prescriber a view of the member's narcotic medication use, which prescribers and members can use to discuss the level of narcotic use.
The program is one of three Blue Cross and Blue Shield Plan initiatives selected by Harvard Medical School researchers as part of the BlueWorks program. Blue Cross and Blue Shield of Florida and Blue Cross of California also were recognized for innovative programs to keep quality healthcare affordable.
"The 'Rule of Three' program uses existing information to better protect consumers from dangerous use of narcotics," said Scott P. Serota, president and Chief Executive Officer of the Blue Cross and Blue Shield Association. "Sharing this knowledge across the Blue system, along with other BlueWorks-recognized innovative programs, helps give consumers access to affordable, quality healthcare."
Programs developed by three Blue Cross and Blue Shield companies were recognized as this quarter's BlueWorks winners, including:
- Anthem Blue Cross and Blue Shield's "Identifying Questionable Narcotic Drug Patterns" program helps physicians identify patients who may be at risk for abuse or overmedication with narcotic prescriptions and encourages ongoing communications between physicians and their patients.
- Blue Cross of California's "Creative Solutions to Asthma Management" addresses the needs of minority populations who are often most at-risk for asthma. Blue Cross of California partnered with local organizations in reaching underserved populations to give their asthma management programs added strength. With the help of a local hospital, asthma education materials were re-written for members with low literacy and language proficiency, and translated into 11 languages.
- Blue Cross and Blue Shield of Florida's "Know Your PT/INR: Blood Thinner Awareness Initiative" is an education program that tackles the problem of venous thromboembolic disease (VTE) and the associated treatment – commonly anticoagulants. Thromboembolic disease is a significant cause of disability and death in the United States, resulting in 300,000 hospitalizations and 50,000 deaths per year. Recently, VTE made headlines as it was recognized to be the blood clotting disease associated with sedentary/immobile behavior during travel. Blue Cross and Blue Shield of Florida designed an educational intervention to improve health literacy regarding anticoagulant safety.
"By identifying programs that work and encouraging their adoption by other health plans, BlueWorks can impact meaningful change, while improving quality and helping to control costs," said Dr. Barbara McNeil, M.D., head of the Department of Health Care Policy at the Harvard Medical School.
BlueWorks programs are evaluated for importance to the healthcare system, potential applicability in other communities and level of innovation. For more information on BlueWorks, visit www.bcbs.com/blueworks.
