Blue Cross and Blue Shield companies are leading the way toward a future where doctors, hospitals, health insurers and patients have the data they need to help make the best decision for their health.
Siloed medical records mean doctors can't see the whole picture
Until recently pieces of the patient healthcare data puzzle lay siloed in different medical records systems, different hospitals, previous health plans and more. BCBS companies, along with industry and nonprofit groups, have been working to put those pieces together to make the healthcare system work better for everyone. An interoperable healthcare system is one in which healthcare organizations share meaningful data, derive insights from that data and put those insights to work to make care more coordinated and cost effective. It's one in which patients have better access to their own data, too.
Putting the data puzzle pieces together to improve patient care
To attain this level of seamless care, BCBS companies and others are working on enabling medical records systems to “talk” to one another; standardizing the kinds of data health systems collect; improving and expanding opportunities to make data available to patients; and designing programs that put data to work to help healthcare providers see the bigger picture of a patient’s health.
Interoperability is about more than sharing data. It will also help improve health equity. When healthcare organizations can collect and share meaningful data about the whole person—such as race and ethnicity—they can identify disparities in health and measure progress in closing them.
Following are examples of the ways in which BCBS companies are moving toward a more interoperable future to empower patients and healthcare providers alike.
Anthem Blue Cross and Blue Shield
Leveraging its digital platform for health and the vast amount of health data it has, Anthem Blue Cross and Blue Shield is focused on delivering data-driven insights to make healthcare more personalized and enhance members’ healthcare experience. The health plan is synthesizing millions of medical records and health insurance claims to make predictions about items such as care gaps and health risks in order to offer members more proactive healthcare options. For example, using these technologies, the health plan has been able to make relatively accurate predictions about the risk of fall among older adults and can now alert healthcare providers about those risks. More work is underway to link medical and claims data with information about other important drivers of health, such as ZIP code and food insecurity, to give healthcare providers a more robust picture of a person’s healthcare needs. Also, Anthem Blue Cross and Blue Shield is a key participant in many of the major interoperability coalitions across industry and government.
For more than 15 years, Regence has worked to improve data sharing across the healthcare system. Through collaborations such as the CARIN Alliance and the HL7, Da Vinci Project to advance data standardization, Regence’s efforts have also helped other organizations comply with federal interoperability mandates. New capabilities have enabled Regence to work with tech giant Apple to improve the member experience using the Apple Health app. In the summer of 2021, Regence unveiled a developer portal, a tool for other companies to connect to Regence’s API (Application Programming Interface). Working with major health systems in the Pacific Northwest, Regence’s efforts to streamline technology processes and give members easy access to their health care data have reduced wait times for pre-authorizations, driven efficiencies in medication management and more.
Florida Blue gives Medicare members access to their clinical and claims information through third-party applications. In addition, the health plan’s provider directory is now publicly available to third-party applications. These tools help members find the right care and ensure it’s coordinated along their health care journey. Florida Blue is currently working on a project that will help new Florida Blue members log into their Florida Blue member portal and request healthcare data from their previous health plan. This allows members to take all of their data with them as they move between health plans.
Blue Cross Blue Shield of Michigan is playing a critical role in driving participation in a statewide Health Information Exchange (HIE). The HIE is a critical component for healthcare organizations to be able to share data that will help patients and healthcare providers make the best decisions about their care when and where needed. Currently, 157 hospitals and 40 physician organizations in BCBS Michigan’s incentive programs, along with 60% of skilled nursing facilities participate in the HIE. Over 11 million admission, discharge or transfer notifications from hospitals and 400,000 care summaries pass through the service every week. BCBS Michigan continues to support efforts to improve the quality of data. New efforts are moving beyond incentivizing providers for receiving HIE data by challenging them to develop projects and solutions that expand the impact of data and technology across organizations and populations. For example, some healthcare providers are developing solutions that deliver real-time alerts to a provider’s mobile device about high-risk patients, enabling them to reduce the chances of an unnecessary hospital admission.
Anthem Blue Cross Blue Shield is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.
Regence BlueCross BlueShield, Regence Blue Shield and Regence BlueShield of Idaho are independent licensees of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies. We refer to them collectively as Regence Blue Cross and Blue Shield companies in this article.
Florida Blue is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.
Blue Cross Blue Shield of Michigan is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.