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Predicting and Prescribing Meaningful Interventions to Manage Rising Member Costs

Hear real-world accounts of challenges employers face with high-cost claimants (HiCCs) in employer-sponsored healthcare. Find out how machine learning-enabled analytics can help to predict HiCCs and what can be done to reduce the cost trajectories for impacted individuals.

BHI Data in Action

  • "The Influence of Physician Payments on the Method of Breast Reconstruction," Journal of the American Society of Plastic Surgeons, October 2018

    Using the Blue Health Intelligence database from 2009 to 2013, patients were identified who underwent tissue expander (i.e., implant) or free-flap breast reconstruction. The implant-to-flap ratio and physician payments were assessed using quadratic modeling. Matched bootstrapped samples from the early and late periods generated probability distributions, approximating the odds of surgeons switching reconstructive method. Click here for the study.

  • "Budget Impact of Increased Payer Adoption of the Flexitouch Advanced Pneumatic Compression Device in Lymphedema patients," Journal of Medical Economics, July 2018

    Budget impact was calculated over 2 years for a hypothetical US payer with 10-million commercial members. Model inputs were derived from published sources and from a case-matched analysis of Blue Health Intelligence (BHI) claims data for the years 2012-2016. Click here for the study.

  • "Benefits of Advanced Pneumatic Compression Devices in Patients with Phlebolymphedema," Journal of Vascular Surgery, June 2018

    This was a longitudinal matched case-control analysis of deidentified private insurance claims. The study used administrative claims data from Blue Health Intelligence for the complete years 2012 through 2016. Patients were continuously enrolled for at least 18 months, diagnosed with phlebolymphedema, and received at least one claim for CONS either alone or in addition to pneumatic compression (SPCDs or APCDs). Click here for the study.

  • "Disease-related Expenditures in Chronic Rhinosinusitis Patients After Endoscopic Sinus Surgery," Journal of Medical Economics, April 2018

    Adults (aged 18-64 years) undergoing ESS for CRS in 2012-2015 were identified within the Blue Health Intelligence database and used to estimate revision rates. Patients with ±1 year of enrollment around the index ESS were used to estimate 1-year healthcare expenditures. Revision ESS rates were evaluated via Kaplan-Meier and Cox regression models. Disease-related healthcare and pharmacy expenditures were modeled with generalized linear regression to assess the impact of baseline patient characteristics. Click here for the study.

  • "Trends in Physician Payments for Breast Reconstruction," Plastic and Reconstructive Surgery, April 2018

    The Blue Health Intelligence database was queried from 2009 to 2013, identifying women with claims for breast reconstruction. Trends in the incidence of surgery and physician reimbursement were characterized by method and year using regression models. Click here for the study.

  • "Costs of Cervical Disc Replacement versus Anterior Cervical Discectomy and Fusion," Spine, April 2015

    This was a retrospective, matched cohort analysis of a prospectively collected database of costs and outcomes for patients aged 18 to 60 years, who were continuously enrolled in a Blue Cross Plan contributing data to a claims database. Inclusion criteria were as follows: all patients who were treated surgically with either CDA or ACDF between January 2008 and December 2009, with single-level cervical pathology and claims reflecting at least 6 weeks of nonsurgical preoperative care without claims history of prior surgery. Click here for the study.


Actionable Analytics for Employers

BHI and Midwest Business Group on Health discussed employers' key priorities for 2019 and highlighted how BHI's employer reporting solution informs decision makers through multi-dimensional analytics and impactful benchmarks.

Know Before You Go: Using Analytics to Maximize Risk Adjustment, Reimbursement and ROI

Medicare and ACA populations and providers are constantly in flux. Therefore, delivering accurate risk scores and impactful interventions for these programs requires intense time and attention. Without that focus, members’ health and BCBS Plans’ revenue are in jeopardy.

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Defining, Targeting, and Decreasing Low-Value Care

BHI's Alan Spiro, MD, and Maria Ferrera lead a discussion around how low-cost, low-value care services are driving an increase in unnecessary care costs, and why targeting low-value care services represents a significant savings opportunity for payers.
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Collecting and Using hidden data on quality: lessons from BHI, Horizon and i3pi

Today, health plans are sharing a greater portion of risk and savings with providers. Now, it's imperative that patients are effectively evaluated and treated to prevent both readmissions and avoidable emergency department (ED) visits. 

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