BCBS Ups its National Data, Care Coordination Game

A pair of announcements from the Blue Cross Blue Shield Association demonstrates its commitment to arming employers, providers, and members with a great wealth of quality and cost data to inform their healthcare decisions.

The 105 million members of the Blue Cross Blue Shield (BCBS) organizations across the U.S. represent a data set too often unanalyzed and underutilized. But two recent announcements indicate that the 36 independent Blues are bringing their health insurance businesses into closer alignment, powered by a vast increase in useful, shared data.

The Blue Cross Blue Shield Association (BCBSA), the federation linking all 36 Blues, in late September, announced BCBS Axis, a data service aggregating 2.3 billion procedures conducted annually from more than 20,000 healthcare facilities and 540,000 physicians.

In late October, BCBSA announced Blue Distinction Total Care, a program for employers that emphasizes prevention, wellness, disease management, and coordinated care while reducing costly duplication and waste in care delivery. The 36 independent Blues all committed to offer Total Care as a nationwide network of offerings.

BCBS Rolls Out 'Total Care' National Network

These two announcements have a thread of connection. The Blues will use BCBS Axis as the data mechanism by which medical professionals can be benchmarked and designated for the Total Care network.

To understand Axis better, I recently spoke with Maureen Sullivan, senior vice president of Strategic Services and chief strategy officer for BCBSA. The transcript below has been lightly edited.

HLM: What does BCBS Axis represent in terms of the journey BCBS has been on to bring all its data into more a usable, actionable form?

Sullivan: There's been a commitment from every [BCBS] CEO stepping up and providing data across every zip code. When you look at the spend on the transparency tools, we've quadrupled the number of treatment categories that are available. What that means is, that for our national employers, for our members, and for our provider partners, they'll have a greater wealth of data to draw on, to inform their decisions.

HLM: How will this help providers?

Sullivan: Axis actually powers what happens at the local BCBS plan level. So when a BCBS plan [offers] benchmarking information to the providers, what they want to be able to show is not only how a certain condition is being treated, and what the outcomes are, and what the costs of episodes are within the state, but comparing it more broadly to other like markets. This gives the type of data depth to be able to do that.

HLM: Does this fit into the current trend toward price and quality transparency?

Sullivan: It absolutely does. We believe strongly that being able to provide our members with the right information at the right time will help them make the decisions that are right for themselves and their families.

HLM: Is this effort collectively funded and collectively managed?

Sullivan: Our board is the CEOs of the individual BCBS companies. The board has come together and made a collective investment here. We're going to build on that investment. And we're going to layer on through that a set of decisions to make sure that this is uniform across the country in terms of the amount of data that's available.

HLM: Do you see an analogy between the transparency you're exposing here and what's going on at CMS with the Medicare data that's being published?

Sullivan: Because we're not actually publishing data, it might not be a direct comparison, but it's similar in [that it helps grow our] understanding of how do we do a better job of getting data available so that anyone can make… more informed decisions.

HLM: Do you see this evolving to a point where you're sharing data the same way that Medicare is sharing? Medicare is sharing a whole lot of data these days, allowing a lot of price shopping going on, right on down to the individual physician level. Is that something that's in the Blues' future as well?

Sullivan: It's interesting. One of our plans, BCBS of North Carolina, took the step of taking their transparency tool and making it available to anyone in the state, not just their members. So [anyone] can get on and get all the information. We're actually watching that closely to understand the value.  

Individual members may find value if [the tool] can reflect… how their healthcare benefits are structured, and what the copays are, deductibles, coinsurance. We want to understand: Does it have value to put the information out there if it doesn't link to the benefits?

A lot of the innovation that we're working on right now makes it more and more tailored and personalized to individuals, so if you have to go and have procedures done, you really want to know what it's going to cost you, based on your benefits, if you're with BCBS, what you spent already, and what's left. So it's an interesting question, to your point of what's the value, and we're actually looking at that, based on what BCBS of North Carolina is doing.

HLM: The collective commitment of all 36 companies makes me wonder, have they all had this view into each other already, before Axis, or does Axis also represent a new level of transparency among the 36?  

Sullivan: It is a new level of transparency with the caveat that if there are two licensees in the market, we keep that separate. Other than that, yes.

HLM: Is what we're seeing today on BCBS Axis complete, or is there is still more to be rolled out?

Sullivan: There will be more data depth in some markets, but you've got most of it right there.

HLM: BCBS Axis includes more than 700,000 reviews of providers by BCBS members. How do we access those reviews?

Sullivan: Members would go on to their local BCBS site.

HLM: Are you publishing APIs so that if a provider wants to do more in-depth analysis of your ratings or your data they could they do that?

Sullivan: What we're doing starting in January, is a much more aggressive effort of reporting out on trends and data, so that it can be used to inform thought leadership and policy makers all the way to a consumer making a choice.  

We've looked at knee and hip price variation and cardiac price variation. We're looking at women's heart health patterns versus men. And we are also beginning to look at a research consortium and giving data to certain academics to ask questions.  

So we are becoming, in that way, much more public with the insights and the value of the data, because we see that as critical for affecting the kind of change we all need in healthcare.

HLM: How difficult was it to get all 36 organizations on board? Were some more eager than others to do it at this time?

Sullivan: I think the strategic argument was reached easily. There were some operational commitments that needed to be made, and given the weight of the strategic argument, the operational issues were able to be addressed.