Blue Health Intelligence’s Certification to Use Medicare Claims Enables a Complete Understanding of Provider Quality in the U.S.

In News by BHI

CHICAGO (June 12, 2019) – Blue Health Intelligence® (BHI®), a leader in healthcare analytics, has been named a certified Qualified Entity (QE) by the Centers for Medicare & Medicaid Services (CMS). With this distinction, BHI will gain access to all Medicare fee-for-service (FFS) claims for acute care, post-acute care, physician office, and pharmacy services for more than 59 million individuals each year.

Based on the scale and breadth of its existing commercial claims data, BHI will have access to CMS data from all 50 states and the District of Columbia. Through its CMS partnership, which is also known as the Medicare Data Sharing for Performance Measurement Program, BHI will combine FFS Medicare data with its already rich set of commercial data which includes 190+ million unique individuals and 19+ billion claims. Based on provisions specified by CMS, BHI will produce provider quality reports and other studies to address healthcare’s Triple Aim – better care for individuals, better health for populations, and lower costs for all.

“We are honored to become a member of the QE program,” said Swati Abbott, BHI’s CEO. “By combining this critical healthcare data with our advanced analytics and transparent methodologies, BHI can share a complete understanding of provider cost and quality across the U.S. We will also be able to produce clinically and statistically valid healthcare insights for every condition, age group, and geography.”

BHI’s access to this combined data will also help answer key industry questions by:

  • Examining care utilization patterns by various population characteristics to see which sites of care and/or policies lead to the best health outcomes
  • Understanding the effect of value-based payments on provider and consumer behavior
  • Determining which initiatives and interventions improve care quality and lower costs

“As data scientists, clinicians, technologists, and business leaders who work side-by-side with health plans, providers, academics, employers and other stakeholders, BHI can’t wait to get started as a QE to help make healthcare better,” Abbott said. “With access to Medicare Parts A, B, and D data, BHI can further realize our mission to provide transformational insights on cost, quality, and outcomes.”

Under its three-year certification, BHI will release its first public provider performance report within one year of receiving Medicare data.

About Blue Health Intelligence®

Leveraging the power of medical and pharmacy claims data from more than 190 million Americans, Blue Health Intelligence (BHI) delivers insights that empower healthcare organizations to improve patient care, reduce costs, and optimize performance. Our team of data analysts, clinicians, IT experts, and epidemiologists provide analytics, software-as-a-service, and in-depth consulting to healthcare stakeholders. Blue Health Intelligence is an independent licensee of the Blue Cross Blue Shield Association and carries the trade name of Health Intelligence Company, LLC.


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