Role of Health Plans It s Time to Get out of the Sandbox Health Record Enablement

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1 National Conference of State Legislatures Health IT Champions New Orleans February 2007 Role of Health Plans It s Time to Get out of the Sandbox Health Record Enablement Blue Cross and Blue Shield of Louisiana 1 Blue Cross and Blue Shield of Louisiana Headquartered in Baton Rouge with eight regional offices State s oldest and largest health insurer, began in 1934 in New Orleans Serves 1.1 million customers 90 percent of all LA providers in networks Tax-paying mutual company, owned by its policyholders Company s subsidiaries include HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc. Company s core strategy addresses cost and quality of health care and the uninsured 2

2 Health Information Technology A National/ Regional and Local Agenda In 2005, established LaHIT Strategy to help enable electronic health records in Louisiana. This is a part of the company s strategy to improve access to quality and affordable healthcare. HIT collaboration started in early 2005 with La. DHH, major hospitals, other state agencies, ehealth Initiatives, and. Katrina has accelerated the collaborative efforts. Adoption and expansion of HIT is essential in the recovery of the healthcare system in Louisiana. 3 October Blue Cross Provides Claims-Based Health Histories to Katrina and Rita Evacuees What is Claims-based Health Record (CHR)? Submitted claims (medical, Rx, lab, etc.) are packaged into clinical episodes Patient-centric information Provides a level of encounter history 3-year view How is it used? CHR is made available to members and providers through secure web portals, or through the company s call center Adoption trend More than 4,800 records have been retrieved by members and providers CHR is available to other members across the state (and not restricted to members in the hurricane-impacted areas) 4

3 Claims-based Health Record PORTALS Authentication Member Identifier CHR Retrieval -Clinical Relevancy -Patient Centricity -Security and Privacy Clinical Episodes Procedures Performed Rx filled Provider information 5 Rx Filled Vaccination/ Immunization Preventive Screenings 6

4 BCBS-Louisiana is enabling EHR capabilities in these four critical areas Health Information Exchange (HIE) Aggregated medical information pulled together from multiple patient record sources of independent healthcare organizations. The information can be delivered at point of care through a common access point across local or regional areas, i.e., through regional health information org (RHIO), health info exchange (HIE). Claims-based Medical Data (Administrative Data) Longitudinal view of medical history Composition of episodes of care History of treatments, prescriptions Shared Electronic Health Record Personal Health Record (Information provided by individual patient) Clinical Systems / Electronic Medical Record / EMR (Provider s Clinical Data) Clinical data about a patient from clinical systems in ambulatory or enterprise hospital settings computer-based patient record (CPR), computer-based order sets, Rx information and management, physician notes, lab results, PACS, etc. Key demographic information, living will, etc. Personal / family history - allergies, medical conditions, etc. Health risk assessment information and other personal health management program 7 Since early 2006, has been participating in HIE development activities around the state Health Information Exchange Clinical safety Avoidance of unnecessary / redundant procedure Identify HIE strategic partnership opportunities Consistent clinical data exchange process The company is working with La Dept of Health and Hospitals, State Medicaid, and key hospitals to establish an operating HIE with sound governance, effective clinical use, sustainable operating model and measurable results. Advancing the national / regional and local HIT agenda Member safety advocacy Enabler of provider EHR capability Louisiana DHH contract with HHS to: -Demonstrate interoperability -Clinical information exchange -Scalable org/technology infrastructure -Provide security / privacy model -Provide operating / business model 8

5 In 2006, introduced e-prescribing as a form of electronic medical record (EMR) Provider EMR Safety Prompt service Implement e-prescribing pilot to 500 physicians Being the first health plan in the state to sponsor a substantial e-rx pilot, Blue Cross wants to encourage wide adoption of EMR in Louisiana. Medication history Adverse drug event prevention Electronic transmission Formulary compliance Customer service Member safety - reduction of ADE Formulary compliance Insurance Plans Connects with Plan to Determine patient eligibility RxHUB Clearinghouse enabling Plan, PBM, Physician interaction Prescriptions checked for interactions formulary compliance at point of care PBMs Patient / Member Physician Practice Import/export data to and from practice management systems / EMR applications Pharmacy Receives prescriptions electronically SureScripts Clearinghouse enabling Physician and Pharmacy interaction Increase adoption of HIT among small to medium physician groups 9 In 2007, will launch a consumer-based PHR strategy Personal Health Record Define PHR strategy advocates patient ownership of health record. The company emphasizes PHR portability which is critical to consumer adoption. Personal continuity of care record emergency use, etc. E-clipboard for consistency Improve engagement with clinicians Consistent patient-provided provided information Consumer advocacy Awareness across Louisiana Increase awareness Ensure security / privacy 10

6 has been leveraging claims-based health record (CHR) to enable electronic health record (EHR) in the clinical setting Claims Health Record Expand CHR with clinically relevant information, e.g., lab data, etc. Expand use of CHR in clinical setting, e.g., emergency department, etc. Clinical safety Longitudinal view of patient- Avoidance of unnecessary / centric continuity of care history redundant procedure Without consistent clinical data exchange process, CHR is viable in facilitating decision support Being among the first in the country to introduce payer-based health record, the company emphasizes the importance of integrating health record with clinical workflow. Member safety advocacy Enabler of provider EHR capability Effective use of health information in a clinical process 11