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 …
How BHI’s Population Advyzer Helped Three Health Plans Achieve Significant ROI in Risk Adjustment
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 …
Prescription Drug Cost Trend Update
In this updated Health of America report, the Blue Cross Blue Shield (BCBS) Association, in collaboration with Blue Health Intelligence, performed a more in-depth review of two types of branded prescription drugs to better understand why generic drugs are not reining in prescription drug costs as anticipated.
How to Build a Successful Big Data Analytics Program in Healthcare
Most hospitals and health systems have started to collect some form of electronic information to help them with population health management, financial decision-making, or patient safety, but few have truly cracked the secret of using big data to generate measurable improvements in quality and revenue. Sanket Shah, Senior Director at Blue Health Intelligence, discusses how organizations struggle with big data …
Using Visual Analytics, Big Data Dashboards for Healthcare Insights
Healthcare organizations’ thirst for insights has intensified over the past few years. Executives want to be able to use data to figure out why something is happening, what to do about it, and what to expect in the future. BHI’s Sanket Shah contributes to this article about how there is a lot of data and why getting actionable insights from …
Fact or Fiction: Five Common Downfalls of Data Visualizations
Just like a photo can be altered to remove imperfections, visuals can be manipulated to support the narration an author wants to portray. Likewise, overly complicated visualizations can be just as deceptive. Thanks to technology, there is a wealth of data at our disposal. By falsely representing that data, we do a disservice to those that would benefit from its …
Hype Cycle for U.S. Healthcare Payers, 2018
Gartner’s health value management business model lays out the rationale and architecture for transformation.
Major Depression: The Impact on Overall Health
The Blue Cross Blue Shield Association examines diagnosed major depressive disorder (major depression) using the breadth and depth of data available through the Blue Cross Blue Shield Health Index.
5 Ways Your Health IT Startup Can Stay Ahead
Entrepreneurs in the health information technology field are very aware that they have entered an industry full of competition and challenges. It calls for an extra level of due diligence among leaders in the field, who need to take extra care to not only keep up, but keep their businesses a few steps ahead of competitors. Sanket Shah, director at …
Childhood Allergies in America
In this report, the Blue Cross Blue Shield (BCBS) Association, in collaboration with Blue Health Intelligence, examines American children diagnosed with different kinds of allergies and allergic reactions.