BlueCross BlueShield of Western New York is sharing claims data via HEALTHeLINK, the region’s health information exchange, to help providers improve care.
The plan wants to help area physicians improve healthcare outcomes for the insurer’s members. To do that, it plans to use the HIE to get data to doctors to enable them to use it to improve care coordination, identify gaps in care and focus on preventive care.
More than 70 practices are getting the data and one or two more health plans could start sharing in the near future according to Daniel Porreca, executive director at HEALTHeLINK.
“Combining clinical and claims data from across the community gives treating providers a more complete picture of their patient’s health using input from all care settings,” says Porreca. “Bringing in the first stream of claims from BlueCross BlueShield represents a significant step to enhancing our ability to support the community for quality of care reporting.”
Shared data also can be used to identify which patients of a physician are bringing down the physician’s own quality scores. By having this data, the doctor can identify diabetic patients in need of an eye exam while also bringing the quality score back up.
The new initiative is part of BlueCross BlueShield’s effort to improve the way care is delivered by transitioning primary care practices to a patient-centered model. By delivering claims data to physicians, the insurer also is helping physicians participate in the Comprehensive Primary Care Plus program by the Centers for Medicare and Medicaid Services, known as CPC+. Western New York is one of four markets initially selected to participate in the program.
Medicare is expected to start sharing its data, hopefully starting in 2019, Porreca adds.
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BlueCross BlueShield was one of the founding members and funders of HEALTHeLINK along with major delivery systems in the western part of the state and regional health plans.
“By sharing data in this capacity, we can strengthen physicians’ ability to provide well-coordinated and high-quality care to our members,” explains Thomas Schenk, senior vice president and chief medical officer at the Blues plan. “The more transparency that we can have between payers and providers, the more effective we can be in making a long-term impact on the overall health of Western New Yorkers.”
