IHIE_cs1
Problem
Anthem Blue Cross and Blue Shield conducted a pilot study with IHIE to supplement Anthem’s claims database with clinical information. The goal of this pilot was to see if IHIE had clinical information – specifically lab results - related to 200,000 commercial members. The staggering amount of clinical information found in this small subset of members was surprising to both organizations.
Solution
Before the pilot, Anthem found clinical results for 10% (20,000) of these members. From the pilot study, IHIE’s database found clinical results in 90% (180,000) of these members. The potential impact of this partnership can be demonstrated in diabetic populations. For example, claims information only shows if a patient has received a check of their blood sugar and cholesterol levels. IHIE found clinical information on 160,000 more members than Anthem had in its own database.

Practically, this information can show if a patient’s diabetes is actually under control. With diabetes as a leading cause of death in the United States, and its high prevalence, partnerships such as this one have the ability to put a real dent in containing healthcare costs. Proper interventions can also provide a higher quality of life for those suffering from diabetes. Moving forward, Anthem and IHIE are exploring how this pilot study can be translated into use in the real-world.
Keywords
payors, commercial payors, population health, healthcare value, healthcare cost, interventions, claims, health insurers, efficiency
Identifier
Dr. David Lee
Vice President, Provider Engagement and Contracting Anthem Blue Cross and Blue Shield
Clinical setting: Other / Payor
Benefits
  • Alerts physicians as to how their patients are doing to drive timely interventions
  • Provides opportunities to reward physicians based on how their patients are doing

  • Pilot represents real-world opportunities to impact the value of healthcare and an efficient way to lower the cost/quality ratio
Quotes

The clinical information can be enormously helpful to Anthem to reward physicians based on their management of these patients.

By identifying patients who need interventions, Anthem, in partnership with our providers, can prevent high-cost and life altering complications for our members. The entire community benefits from this knowledge.