The collaboration showcased in the Analytics and Informatics sessions at this year’s Blue Shield National Summit was amazing. It was impressive to see how BHI and all 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 were especially interested in how plans are creatively using cost and quality benchmarks to make lasting improvements. Health Care Service Corporation, Blue Cross Blue Shield of Wyoming, and Premera Blue Cross shared how different cost and quality drivers – when compared to national, local, and industry metrics – are specifically bending the cost curve and highlighting higher-quality providers. For example, Premera Blue Cross is partnering with BHI to expand its use of customized benchmarking to offer creative solutions such as onsite workplace clinics, telehealth kiosks, or new emergency room benefit designs.
BHI also presented its research on aspects of unintended harm inherent in low-value care (LVC). By combing through our national data, BHI quantified the financial impact of healthcare services that do not meet evidence-based medicine standards or are carried out in ways that can harm members. Our research shows that unnecessary and costly imaging procedures for generalized low-back pain and uncomplicated headache impact more than a third of all eligible members and top the list of LVC services, both in number of procedures and total costs.