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Blue Cross and Blue Shield Initiatives Recognized for Increasing Patient Safety and Efficiency

CHICAGO, Sept. 10 /PRNewswire-USNewswire/ -- The Blue Cross and Blue Shield Association (BCBSA), in collaboration with the Harvard Medical School's Department of Health Care Policy, announced today seven Blue Cross and Blue Shield company initiatives as 2007 BlueWorks(R) winners, in the category of 'Collaborating with Providers.'

BlueWorks is a partnership between BCBSA and the Harvard Medical School Department of Health Care Policy that recognizes the innovative ways Blue Cross and Blue Shield companies are working with doctors and hospitals to increase the efficiency and consistency of care delivery nationwide. Harvard researchers evaluate Blue Cross and Blue Shield local programs on innovation, efficacy, robust design and the potential for program replication. Since 2004, Harvard Medical School's Department of Health Care Policy has named 39 Blue Cross and Blue Shield programs as BlueWorks winners.

The 2007 BlueWorks winners are being recognized during BCBSA's BlueWorks for Providers Week (Sept. 10-14). "The 2007 BlueWorks winners are to be congratulated for designing and implementing programs to improve patient safety and efficiency," said Scott P. Serota, BCBSA president and CEO. "The BlueWorks program allows Blue Cross and Blue Shield companies to share best-practices and ultimately transform the way healthcare is delivered across America."

"We are pleased to work with the Blue Cross and Blue Shield companies as they are committed to collaborating with providers to improve the quality and delivery of care in the U.S.," said Barbara McNeil, M.D., Ph.D., head of the Department of Health Care Policy, Harvard Medical School.

The following BlueWorks winning programs exemplify the Blues' commitment to collaborating with and rewarding local healthcare providers that improve the quality of healthcare and patient safety.

Hospital Patient Safety

In 2003, Anthem Blue Cross and Blue Shield in Virginia launched their quality incentive program, Quality-In-Sights(R) Hospital Incentive Program (Q-HIP). The program is designed to collect data from network hospitals and provide feedback on key quality and safety metrics. Q-HIP has expanded from 16 pilot hospitals to more than 60 hospitals in Virginia, serving more than 90 percent of Anthem members admitted to inpatient care in 2006. To complement Q-HIP, Anthem launched the Quality Physician Performance Program (Q-P3). Q-P3 incorporates outcome, process and quality measures to reward evidence-based medicine and other best practices. Based on data provided by the first eight hospitals with participating physicians, results were encouraging - complication rates in 2004 for angioplasty and cardiac catheterization decreased 50 percent and 29 percent, respectively, from 2003 levels.

Diabetes Disease Management

Recognizing that poor diabetes control is often to blame for considerable medical costs that could be reduced with better monitoring, Blue Cross Blue Shield of North Dakota (BCBSND) piloted a collaborative diabetes disease management program to help address some of the challenges faced by providers treating diabetic members. In 2005, patients joined the pilot study and were given a suite of services, including medication comprehension and self-management education. When comparing measurements taken in 2003 to those taken during BCBSND's Provider-Based Diabetes Disease Management Pilot Program in 2005, BCBSND found that the rise in costs was smaller for members in the study clinic. In addition, there were decreases in emergency room visits and inpatient admissions. BCBSND estimates a $100,000 to $300,000 savings due to the disease management program.

Health Information Technology

In efforts to increase patient safety and reduce costs, Blue Cross and Blue Shield of Massachusetts (BCBSMA) and CareFirst BlueCross BlueShield (CareFirst) are partnering with providers to replace paper prescriptions with electronic prescribing.

Blue Cross Blue Shield of Massachusetts (BCBSMA) understands that implementing health information technology requires a level of commitment, financial support and buy-in from many levels of the healthcare community. With this understanding, BCBSMA implemented a suite of interventions. BCBSMA offers a reimbursement program for providers who use technology to provide e-visits (defined as online, non-urgent consultations between patients and the physicians).

Additionally, BCBSMA formed the e-Rx Collaborative with two other insurers. Collectively, the e-Rx Collaborative provides free e-prescribing devices, service(s) and software to more than 2,500 providers - one of the largest e-prescribing projects nationwide. During the first three and a half years, 10.8 million electronic prescriptions were transmitted through the Collaborative.

CareFirst BlueCross BlueShield collaborates with DrFirst, a healthcare software company, to equip 275 providers with an e-prescribing tool. Participating providers are given a wireless-enabled PDA (personal digital assistant) equipped with e-prescribing software to electronically send prescriptions to their patient's pharmacy. In 2006, participating providers registered a total of 550,000 prescription transactions that resulted in 15,000 drug interaction warnings and 7,400 drug allergy warnings being delivered to physicians. If some or all of these prescription transactions went unnoticed, the patient's health or life could have been jeopardized. CareFirst estimates that the warnings to physicians produced $1.6 million in savings.

Member Experience and Efficiency Improvements

WellPoint's client-facing programs use one of three separate data collection and documentation systems. Often times, communications between providers and the insurer are done by e-mail or fax. To help streamline this communication process, WellPoint developed the Member Activity Summary (MAS) Toolbar. The MAS Toolbar is a real-time, Web based application that places all of a member's high-level information in one secure location. The Toolbar was originally launched at WellPoint companies in California, Georgia, Missouri and Wisconsin. The success of the initial release of the MAS Toolbar has prompted WellPoint to replicate the online program in nine additional states.

Online Pre-Certifications

For some healthcare services, a pre-certification from the insurer to the provider is required. The MyInsuranceManager Web Precert Program (Web Precert) is BlueCross BlueShield of South Carolina's (BCBSSC) innovative program that streamlines the pre-certification process making it more efficient and less costly. By updating their pre-certification process from fax and telephone to an online process, providers are able to receive real-time resolution to some pre-certification requests. Currently, over 46 percent of all pre-certification requests and inquiries are handled online, greatly reducing the use of long-distance telephone calls. BCBSSC has achieved cost savings thanks to Web Precert. If current trends continue, cumulative costs savings due to Web Precert would total $1.4 million by the end of 2007.

Improving Claim Processing

At Blue Cross and Blue Shield of Illinois (BCBSIL), claims processing is a joint responsibility between the insurer and the Medical Groups/Independent Practice Associations (MG/IPA). By forming the Medical Group Advisory Committee, BCBSIL staff was able to improve administrative issues that either slowed or created mistakes in claims processing. Through this collaborative effort of adopting a more efficient process, past due claims sent to MG/IPAs for review dropped from more than 8,400 to only 816 in the same period the following year.

On September 14, 2007, BCBSA is holding a forum at the National Press Club in Washington, D.C., to promote how insurers and providers are working together to improve healthcare quality and patient safety. Representatives from the Premier Inc. healthcare alliance, the Duke University Health System, Blue Cross and Blue Shield of Alabama, and WellPoint, Inc., will be participating in the event. A live webcast of this forum, "Collaborating to Improve Quality and Safety in Healthcare: Results through Shared Commitment", will be available at

The Blue Cross and Blue Shield Association is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 99 million individuals - nearly one-in-three of all Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit

SOURCE Blue Cross Blue Shield Association
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