Empower Consumers and Providers - What the Blues are Doing

The Blue Cross and Blue Shield System is committed to improving the quality, safety and efficiency of healthcare. By promoting greater quality and cost transparency, the Blues are helping consumers participate as partners in their care and make informed healthcare decisions based on quality and cost. Blue Plans also are advancing health information technology initiatives within their communities.

Transparency: Giving Consumers Information to Make Quality-Based Decisions

Last year, 17 Blue Cross and Blue Shield Plans launched a national transparency demonstration to identify the most effective ways to help consumers learn about the costs of medical services, including physician and hospital services. The demonstration leveraged innovative Blue Plan initiatives to share quality and cost information with consumers. These initiatives served as the basis for extensive consumer research to evaluate effective measures and for design of provider selection tools. Below are two examples of approaches that were included in the research:

Blue Cross and Blue Shield of Minnesota's Healthcare Facts program delivers healthcare information as easy to understand as a nutrition label. Consumers can obtain relative cost information ($ - $$$) on hospitals, along with quality information, including number of patients treated for select conditions, nurse-patient ratios and other information. For more information, visit: www.healthcarefacts.org.

Anthem Blue Cross and Blue Shield offers a transparency tool program called "Care Comparison" in select areas of Indiana, Ohio and Kentucky. It provides customers with side-by-side cost comparisons for nearly 40 common medical procedures among local healthcare providers on an episode-of-care basis. The tool is coupled with Anthem’s Healthcare Advisor Hospital Quality Tool to help consumers make informed decisions when selecting among healthcare providers. It will be expanded to additional markets soon.

Based on the results of consumer research, Blue Plans have been working to define a set of baseline standards for the sharing of quality information regarding doctors and hospitals. These standards will be implemented over the course of 2008 on BCBS provider locator Web sites across the country, and will evolve over time to include additional measures and design features.

Health IT Initiatives: Enabling Access to Information to Better Manage Care

Blue Plans are diligently working towards meeting the goal of widespread adoption of health information technology, including adopting electronic and personal health records (PHRs). Plans are leading efforts to:

• promote interoperability through state health information exchanges to enable information to be securely available wherever a patient is being treated
• empower consumers by giving them improved access to their medical information through PHRs
• help providers adopt health IT and improve information at the point-of-care by giving them access to electronic prescribing and electronic health records (EHRs)

Horizon Blue Cross and Blue Shield of New Jersey is helping equip physicians with e-prescribing tools and training them on appropriate use. Not only does this improve safety and quality by reducing medication errors and drug-to-drug interactions, but physicians also report e-prescribing can improve efficiency, allowing them to spend more time with patients. In addition, this tool is able to promote generic and formulary use, saving the consumer money.

Blue Cross and Blue Shield of South Carolina offers physicians a sophisticated swipe-card reader that within seconds sends back information on a patient's eligibility and how much the Plan will pay the physician and how much the patient owes the provider.

Personal Health Records: Helping Consumers Better Manage Their Care

BCBSA strongly believes a PHR can help consumers be better informed and more actively involved in their healthcare. A PHR is a patient-centric summary of personal health information that a patient can access, control and authorize their providers to view. Health plans can auto-populate a PHR with claims data on recent doctor visits, hospital stays, lab results, prescriptions and other information. Patients can add personal and family medical history to form a continuously updated patient medical history.

To help spur adoption and ease of use, BCBSA and America's Health Insurance Plans are collaborating on an industry initiative to identify core elements of a PHR and portability standards so that a consumer's information will transfer from one PHR to another if he or she switches health plans. All Blue Plans are committed to offering PHRs to all our members by the end of 2008.

WellPoint is offering personal health records software to all 34 million of its insured members, based on a pilot program developed by Empire Blue Cross and Blue Shield of New York. It offers members a secure, Internet-based personal health record that is auto-populated with data from processed claims, including doctor visits, lab results, immunizations, hospital stays, reported diagnoses and prescriptions.

Blue Cross and Blue Shield of Florida and Humana announced plans for statewide deployment of the nation's first multiple payer electronic health record, the Availity® Care Profile (ACP). The ACP is an electronic health record that provides a consolidated view of patients' healthcare services across physicians and providers to help improve patient safety, eliminate duplicate procedures and aid in reducing unnecessary services and fraud. The launch of the ACP facilitates improved sharing of health information and interoperability between clinicians and multiple payers, resulting in efficiencies and cost savings.

Consumer-Directed Health Products: Helping Consumers Make Informed, Cost Conscious Healthcare Choices

Blue Plans across the country are offering a variety of consumer-driven health plans (CDHPs) that include a financial account funded by the consumer, employer or both and are tied to a health insurance product that will cover large expenses. These products allow consumers to take greater personal responsibility for their own health and healthcare. While these products are still new, a 2007 study by BCBSA revealed the following:

• CDHP consumers were more likely to seek information about insurance as well as about doctor and hospital quality and cost.
• Americans covered by CDHPs were 17 percent more likely to participate in an exercise program - and more likely to see positive results.
• Sixty-three percent of consumers in CDHPs tracked their healthcare expenses compared to 43 percent of non-CDHP consumers.

Next: What the Government Should Do.