Though the majority of the healthcare industry recognizes the impact social determinants have on overall health, collecting this data has proved challenging. Providers often feel that they don’t have the time or the resources to gather and capture this data, which can keep them from addressing the barriers that affect their patient populations. Shah discusses what some organizations are advising to help …
The collaboration showcased in the Analytics and Informatics sessions at this year’s Blue Cross Blue Shield National Summit was amazing. It was impressive to see how BHI and the Blue Plans are working to assure that AI, machine learning, data analytics, and predictive modeling are being combined with real-world knowledge to produce meaningful solutions for payers, members, and providers. Attendees …
Using our massive data repository and powerful analytic tools, BHI regularly examines high-level cost and utilization trends. In the most recent dive into our big data, comprised of more than 19 billion claims from over 190 million members, three trends stood out. PMPM Costs Continue to Climb At a macro level, total commercial health plan PMPM costs rose 6.5% — …
Predicting when and where disease will occur would be of great assistance to medical professionals and public health officials, who could more aggressively focus public awareness campaigns and other programs on certain populations to inhibit the development and spread of measles, or other potentially deadly viruses. In fact, the World Health Organization’s risk assessment tool has been successfully used to …
There is a tremendous opportunity for VR (virtual reality) and AR (augmented reality) solutions to help healthcare providers unlock the value of vast amounts of health data that have never been used to their full potential. By leveraging this trove of information, organizations will have opportunities to significantly reduce costs and provide higher-quality patient care. Technology companies are racing to …
Once thought of as technophobes, seniors today have their own reasons for embracing today’s technologies. Sure, they want to stay in touch with loved ones like other, younger demographics, but they are also finding out that smart devices, smart apps, and smart homes can help them to stay in their homes longer while offering their loved ones more peace of …
In many contexts, adverse events are identified, with good reason, for the purpose of identifying errors or where processes can be improved. But as a result, some adverse events may be excluded from those counts because they are “clinically expected” given patient comorbidities and other issues. BHI’s attempt to paint a ‘real-world’ picture of ‘what went wrong’, by limiting exclusions …
Among regional health plans, a recent Blue Health Intelligence (BHI) analysis found that the number of very high-cost claimants (HCCs) — members with more than $500,000 in annual claims — has nearly doubled over the last five years. Previous research shows that specialty pharmacy is a major factor in this growth. However, out-of-area claims are not a large factor in this growth. …
Unnecessary care that provides little to no clinical benefit, and services performed in high-priced or inappropriate settings are costing health plans billions each year. Eliminating Unnecessary Care To determine the extent of unwarranted tests, prescriptions, and procedures being delivered within health plans, data scientists from Blue Health Intelligence® (BHI®) examined claims from more than 39 million eligible members. Of the …
Challenge Health plans today want greater internal control of their Affordable Care Act (ACA) and Medicare Advantage risk adjustment programs and increased visibility into the risk adjustment process. No longer content to rely on broad-brush chart reviews, provider engagement, and in-home assessments, health plans instead want greater accuracy, efficiency, and transparency in how members are selected and which interventions are …