New Reports from BHI Analyze What’s Behind the Cost Dilemma Facing U.S. Healthcare

In News by BHI

CHICAGO (March 13, 2020) – Blue Health Intelligence® (BHI®) has issued three new studies examining the state of healthcare costs, the leading contributors to health cost inflation, projected to result in $6 trillion in healthcare spending by 2027.

All three studies draw on BHI’s data warehouse of claims from more than 200 million plan members, the largest and most longitudinally rich national data set in the U.S., which helps deliver insights that are timely, actionable, and relevant for U.S. healthcare stakeholders.

In the first report, Cost of Care Snapshot: 3-Year Trends, BHI’s analysis of cost and utilization metrics from 2016 to 2018 found costs increased at a higher rate than utilization. Within the context of major product and service categories, the analysis discovered:

  • Costs increased across almost all selected categories over the three years, outpacing healthcare utilization
  • Care settings continue to have a huge impact on costs
  • The prescription drug cost gap is still widening, as name-brand drug prices continue to rise year-after-year

In a second report, Stop the Bleeding: the Widespread Impact of Healthcare Waste, BHI analyzed claims data of 20.5 million qualifying members and discovered nearly 9.3% (1.9 million) had received tests and procedures that contain risks and/or have little or no clinical benefit. BHI studied 16 measures of low-value care based on recommendations from Choosing Wisely®, an initiative of the ABIM Foundation, and found the total cost of unneeded care in 2018 for these measures totaled more than $1 billion. For example, $225 million was spent unnecessarily for imaging non-specific lower back pain.

And in the third report, Predicting High-Cost Claimants to Avert Unnecessary Spending, BHI found that health plan members with high-cost and very high-cost medical claims are consuming more and more of the total healthcare spend in the U.S. Members with allowed annual costs exceeding $250,000 increased by 30.4% from 2016 to 2018, costing $21.6 billion. Additionally, members with allowed annual costs between $50,000 and $249,999 increased by 15.8%, costing $75.3 billion.

“The ability to predict which individuals are on a path to high cost, and which interventions have the best chance of preventing that eventuality, has become critically important,” the report states.

“Using data analytics and predictive and prescriptive methodologies to detect unusual patterns in spending by state, region, cost of service, gender, and other less-obvious factors may hold great potential for lowering costs and improving care quality,” said Swati Abbott, BHI’s CEO. “With the scale of our data and the advanced analytics we use, BHI is uniquely able to identify key strategies for improving the healthcare ecosystem.”

One example of the power of healthcare analytics found in BHI’s analysis was how the healthcare system could save billions each year if it directed low or moderately complex services to less-intensive settings and the most appropriate providers. BHI found that for every $500 million in medical costs, about $12.5 million could be saved by shifting care from hospitals to medical offices.

About Blue Health Intelligence

Leveraging the power of medical and pharmacy claims data from more than 200 million Americans, Blue Health Intelligence® (BHI®) delivers insights that empower healthcare organizations to improve care, reduce costs, and optimize performance. With the largest, most up-to-date, and uniform data set in healthcare, BHI provides an accurate representation of the health profile of commercially insured Americans. Our team of data analysts, clinicians, IT experts, and epidemiologists provide analytics, software-as-a-service, and in-depth consulting to payers, providers, employers, medical device companies, and other healthcare stakeholders. BHI is an independent licensee of the Blue Cross Blue Shield Association and carries the trade name of Health Intelligence Company, LLC. For more, visit

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