Blue Cross of Idaho episodes of care program posts savings

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IBM has awarded Blue Cross of Idaho the 2019 IBM Watson Health Advantage Award for its use of data analytics to improve outcomes and lower costs in episodes of care.

The episodes of care program, begun in 2014—it’s saved Meridian, Idaho-based Blue Cross of Idaho, the largest health insurer in the state, $6.5 million annually at its latest ROI analysis, conducted in 2017, according to Drew Hobby, senior vice president for healthcare economics for Blue Cross of Idaho.

Blue Cross of Idaho’s three-tired commercial fee schedule, which uses IBM Health Insights software, reviews the total cost of care for a medical episode and then tiers the physician or clinic on performance. Physicians and clinics then undergo a peer-to-peer comparison to evaluate efficiency across the state, according to Hobby.

“Blue Cross of Idaho is using IBM Health Insights to arm doctors with data about the complexity of care – office visits, physical therapy, surgery and anesthesia,” Hobby says. “Often, doctors do not have the information about facilities or medications that offer high-quality results at a lower cost. We rank a provider against his or her peers on the cost-efficiency of care. We’re proud to use the most advanced healthcare technology to improve performance throughout the entire continuum of care.”

Blue Cross of Idaho processes more than half of its member claims through value-based arrangements, Holly says. “Our largest users are our orthopedic surgeons, and we’ve seen a 3 percent decline in orthopedic costs since we’ve been sharing the data. Additionally, we’ve seen a 15 percent reduction in surgery claims and emergency room use—this was 41 percent lower for our members in a value-based system.”

Under the program, the health plan issues commercial scorecards on a quarterly basis, Holly says. The scorecards profile eight different specialties that typically involve approximately 600 clinics, 3,100 practitioners and 420,000 episodes.

The physicians have supported the program and share the health plan’s passion for affordability and high-quality care, according to Holly. “We’re delivering data to our doctors to ensure that Idahoans receive high-quality care that’s efficient and affordable,” he says. “Arming doctors with data about their practices has been powerful, and it helps them drive patients to lower cost, higher-quality facilities. A less expensive hospital or facility also leads to happier patients.”

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Healthcare analytics Value-based care Health insurance Healthcare plans Quality of care Healthcare costs