Role of Health Plans eRx and Health Record Enablement

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Role of Health Planse-Rx andHealth Record
Enablement
Louisiana Health Care Commission March 23, 2007

• Blue Cross and Blue Shield of Louisiana

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Blue Cross and Blue Shield of Louisiana

• Headquartered in Baton Rouge with eight regional
  offices.
• States oldest and largest health insurer, began
  in 1934 in New Orleans.
• Serves 1.1 million customers.
• 90 percent of all LA providers in BCBSLA
  networks.
• Tax-paying mutual company, owned by its
  policyholders.
• Companys subsidiaries include HMO Louisiana,
  Inc. and Southern National Life Insurance
  Company, Inc.
• Companys core strategy addresses cost and
  quality of health care and the uninsured.

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Health Information Technology A National/
Regional and Local Agenda

• In 2005, BCBSLA established LaHIT Strategy to
  help enable electronic health records in
  Louisiana. This is a part of the companys
  strategy to improve access to quality and
  affordable healthcare.
• HIT collaboration started in early 2005 with
  Louisiana DHH, major hospitals, other state
  agencies, eHealth Initiatives, and BCBSLA.
  Katrina has accelerated the collaborative
  efforts.
• Adoption and expansion of HIT is essential in the
  recovery of the healthcare system in Louisiana.

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BCBS-Louisiana is enabling EHR capabilities in
these four critical areas
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In 2006, BCBSLA introduced e-prescribing as a
form of electronic medical record (EMR)
Implement e-prescribing pilot to 500 physicians
Being the first health plan in the state to
sponsor a substantial e-Rx program, Blue Cross
wants to encourage wide adoption of EMR in
Louisiana.
Increase adoption of HIT among small to medium
physician groups
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Blue Cross E-Rx Program Status

• Program subsidizes Handheld device, one-year
  ePrescribing application license, training and
  support per doctor, provided by Zix
• 500 High-prescribing providers recruited
  statewide
• 364 Providers fully deployed and actively
  writing electronic scripts
• 10,500 Average of weekly e-Prescriptions
  written during 2/07
• 1,500 Average of weekly BCBSLA e-Prescriptions
  written during 2/07
• Program Metrics Measure of Success
• 4 Generic Rate Shift
• 4 Formulary Compliance Rate Shift
• 0.5 Therapeutic Alternative Rate Shift
• 90 Physician Satisfaction
• 450 Providers averaging 25 scripts/month for 12
  months (or 300 scripts total)
• 212 providers are currently averaging 25
  scripts/month
• 146 providers have written 300 scripts each

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October 2005 - Blue Cross Provides Claims-Based
Health Histories to Katrina and Rita Evacuees

• What is Blue Health Record?
• 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 BCBSLA members and
  providers through secure web portals or through
  the companys call center
• Adoption trend
• Thousands of 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)

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Claims-based Health Record
PORTALS
Authentication
Member Identifier

• Clinical Relevancy
• Patient Centricity
• Security and Privacy

CHR Retrieval
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BCBSLA has been leveraging claims-based health
record (CHR) to enable electronic health record
(EHR) in the clinical setting
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.
Expand use of CHR in clinical setting, e.g.,
emergency department, etc.
Expand CHR with clinically relevant information,
e.g., lab data, etc.
Effective use of health information in a clinical
process
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Since early 2006, BCBSLA has been participating
in RHIO/HIE development activities around the
state
The company is working with Louisiana Department
of Health and Hospitals, State Medicaid, key
hospitals to establish an operating HIE with
sound governance, effective clinical use,
sustainable operating model and measurable
results.
Identify HIE strategic partnership opportunities

• Louisiana DHH contract with HHS to
• Demonstrate interoperability
• Clinical information exchange
• Scalable org/technology infrastructure
• Provide security / privacy model
• Provide operating / business model

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In 2007, BCBSLA will launch a consumer-based PHR
strategy
BCBSLA advocates patient ownership of health
record. The company emphasizes PHR portability
which is critical to consumer adoption.
Define PHR strategy
Increase awareness Ensure security / privacy