While Computer Sciences Corp.'s Blue Health Intelligence data warehouse has been deployed at only three Blues plans since July, the industry is beginning to recognize the benefits this type of warehouse can bring.
Blue Cross Blue Shield of Minnesota is now able to help multi-state employer groups refine benchmarks for diagnostic work more accurately and find solutions relevant for each state in which it operates, said David Plocher, MD, chief medical officer.
With Blue Health Intelligence (BHI), self-insured employers operating in several states can examine healthcare cost drivers in each state and adjust claims experience using state-specific benchmarks, resulting in reduced claims cost.
Conceptually, the payer's financial advantage is that it would become more competitive, winning and retaining agreements with large self-insured multi-state employers.
BHI also will help payers manage risk and forecast costs, said David Hampshire, senior partner for CSC's global health solutions practice.
"The quality of national benchmarks and statistics that come out of this database will let actuaries perform more accurate analyses and improve the precision of underwriting risk and medical loss ratios," he said.
As the largest database in the nation, comprising data gleaned from 79 million people, the BHI has the potential to help identify national trends for disease management and assist pay-for-performance programs.
"The biggest challenge to measuring quality is the standardization of data," said Hampshire, but the breadth and quality of BHI will help deliver more accurate national benchmarks and statistics.
Bill Whitely, chief medical officer of Ingenix, said his clients - payers and large self-funded employers - either manage cost or quality on a prospective, concurrent or retrospective basis.
Payers can use data to predict and identify high-risk members for early intervention and recruitment into a care management program. It also can identify cost-oriented developing trends for contract pricing negotiations.
A robust database can generate reports to all constituent groups, provide data so case managers can better manage their patients and assist in claim editing and fraud monitoring.
On a retrospective basis, the database can analyze outcomes and help payers refine existing or develop new care programs.
"If you use the data warehouse well, you can manage the entire lifecycle of cost and quality," Whitely said.