Health insurer Premera Blue Cross, serving the states of Alaska and Washington, is amassing data to build a complete picture of each of its members and to improve its ability to solve problems and more effectively managing risk.
The objective is to identify members who are not getting the healthcare services they need, or conversely, are getting services they don’t need, says Colt Courtright, director of corporate data and analytics. “Members are paying for insurance, and the company is trying to improve their experience.”
For example, a member may have an injury and go to a facility’s emergency department, but member’s primary care physician often isn’t informed about the intervention.
“By combining claims and clinical data, we enable providers to better understand a patient’s health in real time,” Courtright explains. “A doctor knows what prescriptions have been written, but not if they have been filled. Combining data fills that gap and gives doctors a more complete picture of their patients’ health, empowering a richer care environment.”
Premera is using the HealthShare health information exchange technology platform of InterSystems to manage data and get it to the doctors. Provider and payer data on the same platform is coming from HIEs, provider groups, electronic medical records and insurance claims.
The insurer is leveraging its member data to alert primary care physicians in real time, using secure messaging software from Vayuspher, that a patient has been seen by another physician and Premera will send over information on the ER visit such as the emergency physician’s name and medications prescribed.
Premera further can use data to remind a primary care physician that a diabetic patient is overdue for a laboratory test or foot exam. And the insurer also can use secure messaging to contact the patient and explain why it is important to have the tests.
“We are working with InterSystems as part of Premera’s strategy to leverage data in a meaningful way that provides direct benefits for our customers,” Courtright says. “Premera has the potential to better evaluate health risk and support patients with higher-level care needs.”
InterSystems’ data platform includes analytics technology that is easy enough for non-technical employees to conduct their own analytics, according to Courtright.
Implementation of the program was surprisingly easy, but there was one unanticipated hurdle to jump over, Courtright recalls. Despite use of electronic health records and other information systems, a lot of stakeholders still rely heavily on faxes, email and PDFs, and Premera was no exception. “Early on, there was this disbelief that we could move to real time data exchange and not use the faxes, emails and PDFs.”
Courtright encourages insurers and providers to move toward platform-based and analytics-driven environments because when healthcare entities collaborate electronically, the entire healthcare system improves.
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