In what Blue Cross and Blue Shield of Illinois is calling a "game changer" for independent physicians, the state's largest insurer is for the first time sharing data that will help doctors find the best healthcare services based on quality and price for their patients.
On Aug. 1, Blue Cross launched an initiative with DuPage Medical Group, the largest independent physicians group in the Chicago area, in which the insurer is sharing information on the cost and quality of services that DuPage Medical patients receive when they get care outside the group. The data will help physicians see, for example, if a hospital to which they send patients has a high rate of readmitting patients or of patients getting infections.
“Our biggest limitation is the fact that once the patient leaves our domain in any way, we don't have that information in our medical record,” said Michael Kasper, CEO of Downers Grove-based DuPage Medical.
Knowing how often patients end up in the ER, have an expensive CT scan or stay overnight in the hospital is crucial to doctors these days. Under federal health reform, physicians are increasingly paid by insurers to prevent patients from getting sick in the first place and to avoid costly and unnecessary procedures and hospital visits. They can get bonuses for hitting certain quality measures, and lose money if they don't.
Traditionally, doctors were paid based on how many services they provided, which did little to prevent wasteful spending and redundant testing.
In the next five years, Blue Cross wants 75% of its 8.1 million members in a health plan where their physicians can share in savings with the insurer if they improve care while lowering costs.
Blue Cross recognized that would be tough for independent physicians who might lack the resources of their peers who are employed by hospitals and health systems, said Donna Levigne, vice president of risk-based networks for Blue Cross. Improving patients' health can involve large investments, such as electronic medical records systems or hiring staff to monitor patients to make sure that they take their medications on time.
That's why the insurer is rolling out this new initiative, beginning with DuPage Medical, which has about 425 physicians.
“Independent physician organizations have come to us and said, 'How do we participate in this space? How are we relevant going forward?' " Levigne said. "Part of the opportunity here is really giving them access to (information) they don't have access to today.”
Levigne said Blue Cross is providing the service free.
Doctors on a hospital's payroll often refer their patients to their hospital. But independent physicians can be affiliated with several facilities. Using the Blue Cross data, independent doctors can determine which hospital provides the best quality and cost for a particular procedure and get an incentive from the insurer for sending their patients there.
About 40% of DuPage Medicals' more than 500,000 patients are insured by Blue Cross. Of those Blue Cross patients, more than half are in a plan where DuPage is at a greater financial risk for their care.
Data about hospital readmission rates and other measures are publicly available through the federal Centers for Medicare and Medicaid Services. But it's often lagging.
“This is going to be transformational,” said Kasper, who was a Modern Healthcare Up & Comer in 2012. “Our doctors I think have clamored for this kind of information because all of our physicians are focused on quality, efficiency and access for our patients.”
Blue Cross is already reaching out to other physicians groups about participating in the program.
"Blue Cross offering physicians a peek into its trove of patient data" originally appeared on the website of Crain's Chicago Business.