Payers Lure Providers With Big Data - InformationWeek

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Healthcare // Clinical Information Systems
11:09 AM

Payers Lure Providers With Big Data

Blue Cross and Blue Shield Association affiliate's acquisition of Intelimedix is latest attempt to offer actionable clinical information for quality improvement.

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In yet another attempt to bridge the historically antagonistic payer and provider sides of healthcare, a company owned by the Blue Cross and Blue Shield Association (BCBSA) and member plans has acquired healthcare analytics firm Intelimedix. The addition will bring additional business intelligence to an extensive Blues database and, the association hopes, more opportunities to collaborate with providers in the era of accountable care.

Intelimedix becomes part of Blue Health Intelligence (BHI), an independently run entity owned by the BCBSA and 23 Blue Cross and Blue Shield plans, and allows BHI to create an "Informatics Center of Excellence" for Blues companies to tap into.

Other companies have also been beefing up their analytics capabilities through acquisitions recently. Optum, the analytics unit of UnitedHealth Group, just announced a partnership with the Mayo Clinic, while consulting firm Deloitte bought Recombinant Data in October. Health Care Service Corp., the largest not-for-profit Blues licensee, has owned MEDecision since 2008.

[ How can big data improve the quality of healthcare? See 7 Big Data Solutions Try To Reshape Healthcare. ]

Intelimedix, which specializes in reporting for payers and employer groups, has built a "very technical" business intelligence engine within the last year, Blue Health Intelligence CEO Swati Abbott told InformationWeek Healthcare. BHI will adapt the intelligence for its own database of medical and pharmacy claims.

Since BHI started in 2006 as a Blue Cross and Blue Shield Association project with ownership from the association and 18 member plans, BHI has collected de-identified records on 110 million people, about half of whom are active Blues members, Abbott said. Five more Blues plans have since come on board, and the owners spun BHI off as a separate company in December 2010. Abbott, former president of MEDai, a healthcare analytics company now owned by Elsevier, was hired five months later.

The BHI data warehouse of pharmacy and medical claims contains risk-adjusted, "normalized" information, according to Abbott. "Every element means the same thing across the country," she explained, and provides a broad longitudinal view of patient health status.

"We are trying to get clinical data in there too," Abbott added. That, of course, will take cooperation from providers, which the Patient Protection and Affordable Care Act is trying to encourage with bundled payments and shared risk. "Risk sharing is good, but data sharing also is a nice thing," Abbott said. "We group episodes together now."

That's where the provider cooperation comes in, because the payer data allows for benchmarking on such points as quality measures and complication rates. "Because the data is so clear, you can look across the continuum and across multiple hospitals," Abbott said. BHI mined its data last year to determine that the Crozer-Chester Medical Center in Upland, Pa., had one of the lowest rates of potentially avoidable complications in the nation for bariatric surgery, for example.

Abbott said the addition of Intelimedix will bring greater benchmarking opportunities and thus better relations with providers, and ideally, better patient care. "[The clinically relevant analytics] fosters communications and collaboration with payers, the providers, and ultimately the patients," she said.

Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)

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