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Insurer Says Technology Acquisition To Transform Patient Care

Health Care Service hopes patients will have better outcomes and its costs will be reduced with its purchase of disease management software maker MEDecision.

Because doctors spend much of their time "moving from one room to the next" in caring for patients each day, it's often difficult for them to keep close tabs on high-risk patients after the patients leave the office. "We gave a rich store of information that translates to valuable information for patients, physicians, and payers," said St. Clair. "Physicians can't act on what they don't know. A tool to identify adult diabetics who haven't had an eye exam lately is a start in transforming health care."

"If you're a doctor where 40% to 50% of your patients are part of Blue Cross Blue Shield, you have market value" in helping to transform health care by becoming actively involved with programs like care management, said Gerardi. HCSC members are spread across four states: Illinois, New Mexico, Oklahoma, and Texas.

While the goal is to improve the care of HCSC members, in the bigger picture, the use of the technology can help trigger new care-management programs by other insurers, including other Blue Cross Blue Shield organizations, to "transform the overall industry," said St. Clair.

That's because cumulatively Blue Cross Blue Shield organizations represent one of the biggest payers of health care in the country (especially through their Medicare and federal employee programs.) "We hope to influence decisions," said St. Clair.

MEDecision is also evaluating relationships with some of the emerging providers of consumer-oriented personal health record systems, like Google, RevolutionHealth, Web MD, and Microsoft, to reach out to consumers and doctors for care management, said St. Clair.

HCSC is also evaluating ways to use MEDecision's technology to help get members themselves more proactively involved with wellness and care management programs.

"We have a member portal with [member health-care] information, but to be quite honest, utilization is not as high as we'd like," said Gerardi. To engage more members via the Web, HCSC is evaluating consumer relationships with online providers of personal health records, like Google and Microsoft.

HCSC isn't the first large user of health care-IT to acquire or partner with its technology vendor.

For instance, University of Pittsburgh Medical Center has a history of forging such relationships with technology vendors, including a $35 million joint-development and equity stake deal two years ago with DBMotion, an Israeli-based provider of data-sharing software for the health care industry.

This article was edited on 9/3 to correct Health Care Service Corp's ranking.

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