Health insurer leverages clinical data assets to improve care quality, manage commercial risk
InterSystems Corporation, a global leader in health IT, today announced a groundbreaking collaboration with Premera Blue Cross, a not-for-profit Blue Cross Blue Shield licensee in Alaska and a Blue Cross licensee in Washington State.
Premera is using InterSystems HealthShare to bring together clinical data from health information exchanges, provider group electronic medical records (EMRs), along with claims to build a complete picture of each of its members. By doing so, Premera can more effectively manage risk and utilise data to support its purpose of "improving customers' lives by making healthcare work better".
"By combining claims and clinical data, we enable providers to better understand a patient's health issues in real-time," says Colt Courtright, Director of Corporate Data and Analytics at Premera. "For example, a doctor knows what prescriptions have been written, but not if they have been filled. Combining clinical and claims data in real-time fills that gap and gives doctors a much more complete picture of their patients' health, empowering a richer care experience."
Premera and InterSystems began their initial partnership in 2017, when they used HealthShare to connect to the Alaska health information exchange, healtheconnect Alaska, to bring in 150 000 patient records from across the state. After rapidly achieving a series of milestones through HealthShare's real-time data access, Premera expanded the services to add its Washington-based customers, and then later to 11 other states. To date, Premera receives inpatient and emergency department (ED) alerts from contracted data sources across these 11 US states from more than 400 EMRs driving efficient and holistic care to its customers.
"We are only scratching the surface when it comes to utilising big data to its full potential in healthcare. We are working with InterSystems as part of Premera's strategy to leverage data in a meaningful way that provides direct benefits for our customers," Courtright said. "Since implementing HealthShare, Premera has the potential to better evaluate health risk, and support patients with higher-level care needs.
"We submit claims every year to CMS that demonstrate the risk we've taken on based on our customer population," said Courtright. "Increased insight into a customer's complete health picture, and the ability to manage risk in real-time, we believe will prove to be invaluable to our organisation."
"Disconnects between providers and patients have been, and will continue to be, a huge pain point in our healthcare system," said Don Woodlock, vice-president of HealthShare at InterSystems. "Bringing together clinical and claims data provides Premera greater insight into their customers and allows them to innovate in new and exciting ways. This allows them to be better partners and collaborators with their network of providers, which leads to better outcomes for everyone."