Power to the People

From the November 2006 Issue

Power to the People

Blue Cross Blue Shield of Georgia creates a comprehensive Web-based health opportunity and gives members their own PHRs.

By Robin Blair, Editor

Staying competitive—it’s a phrase that many hospitals and physician practices have recently begun to appreciate, and also one that many have begun to embrace with programs aimed at their ultimate end-users—patients.

But not so with health plans and payers; they aren’t newcomers to competition. For decades, they have met the need to deliver innovative products and services at competitive prices to their customers—employers, brokers and agents, and plan members—and have distinguished themselves as a healthcare segment dedicated to staying ahead of the consumerism curve.

Insight on One Site
For some patients and consumers in search of healthcare information, the plethora of available Internet portals has watered down their significance. When a consumer must click away to nine or 10 Web sites to amass a modest collection of health information, how much of a portal is it, really?

It is interesting that Blue Cross Blue Shield of Georgia (BCBSGa) doesn’t apply the term “portal” in its explanation of 360° Health. Instead, it chooses to call the 360° Health program a “single point of contact” for BCBSGa members who want to review and input their personal health data, or search for health information related to health maintenance, wellness and prevention, or to specific chronic conditions.

This is no small opportunity. BCBSGa has about 3.1 million members who can use 360° Health. Health plan officials say that like many Blue Cross affiliates and other large health plans, about 20 percent of their members have acute-care needs or chronic care needs that can be serviced by the program, while the other 80 percent represent a relatively healthy population that may be looking for wellness health maintenance information instead. For all of them, 360° Health will be a gateway to the health plan’s health coaching program, discounts on health and fitness services, plan-sponsored seminars and workshops, and specialized information on chronic conditions, exercise, nutrition and controlling of risk factors.

“As part of our long-range health services strategy, we wanted to create an umbrella of services that members could navigate through more easily than navigating to more than 50 individual services,” which is an accurate estimate of the number of services available plan members, says BCBAGa Medical Director Daniel Salinas, M.D. The health plan is conscious of the navigational environments that consumers face on the Internet as they acquire other goods, services or information and wanted to replicate that ease of use in providing access to health information.

PHRs Are the Foundation
Blue Cross Blue Shield of Georgia is the largest health insurance provider in the state, and is part of the WellPoint Inc., one of the country’s largest publicly traded healthcare companies. BCBSGa employs about 3,000 people throughout the state.

Salinas says BCBSGa was fortunate that 360° Health was first piloted at Empire Blue Cross in New York for up to a year and a half, giving the Georgia health plan the benefit of Empire’s experience and lessons learned.

A cornerstone component of the program is the personal health record (PHR), available for BCBSGa members in this quarter. The PHR was designed to be owned and operated by plan members, an Internet-based tool that they can input into and use in a variety of ways—and, as well, a tool that includes pertinent claims-based data so members don’t have to create their personal health histories from scratch.

In creating their PHRs, members can contribute information extending beyond basic demographics to include allergies or sensitivities to medications or food, immunization records and documentation of their family’s medical histories. The health plan adds online availability, of course, along with data security measures and a certainty of HIPAA compliance. It also populates each member’s PHR with claims data and lab data, bringing into each member’s PHR a claims-based record of healthcare consultations sought and treatment delivered, but in ways that are clinically clear to providers while still being clear in layman’s terms to members.

“When providers send claims,” says Salinas, “the system is able to identify single and multiple ICD-9 codes and translate those into layman’s English, so that members can use their PHRs on an everyday basis.” For example, diagnostic codes related to hypertension also can be represented as treatment efforts to control high blood pressure for the member’s understanding.

The goal of 360° Health, says Salinas, is to give members access to a high volume of both condition-specific and preventive health information already vetted by the health plan, as well as PHRs that they can print out and share with physicians. It is one of many steps Salinas says BCBSGa is taking to provide customized member services before that government-initiated deadline, be it 2011, 2014 or 2024, approaches when all healthcare systems should be able to interoperate and exchange pertinent patient data. In short order, BCBSGa expects that its network physicians, both primary care physicians and specialists, will be able to share online access to members’ PHRs when authorized by the members themselves.

In addition, BCBSGa members also have available Web-based information for hospital cost-comparisons via Subimo-powered functionality.

Not Just Another Pretty Web Site
Does all this matter? Haven’t healthcare organizations been designing and stocking consumer Web sites for years now? Actually, it does matter—over and above the convenience of electronic one-stop-shopping, too.

In late September, United Benefit Advisors (UBA), a consortium of about 140 independent benefit advisory firms, published a summary of its second annual Employer Opinion Survey on Healthcare. UBA Cofounder David LoCascio said that employers’ perceptions about the cost-containment potential of disease management and wellness programs have reached a tipping point; in the future, their shift will be toward these efforts and away from achieving cost improvement through benefit reduction. “The focus for many employers has clearly shifted to preventing and managing employee health rather than solely cutting benefits and/or increasing employee contributions,” he said publicly. More than 90 percent of 1,094 employers surveyed said they believe costs will shift more to employees in the next five years, and more than half said consumer-directed health plans will figure prominently in the future of health benefits coverage.

If this is true, then health plan members will need to fruitfully use all empowerment opportunities and learn to become activated partners in managing their own healthcare and health costs, along with their physicians. For BCBSGa members, the journey can start right at home, right now.