When Health Care Service Corp. -- the nation's fourth-largest insurer and the largest Blue Cross provider -- acquired clinical analytics software provider MEDecision late last month, the insurer not only set out to improve care for its own 12.5 million members, it hoped to trigger a trend to help transform the nation's health-care system.
HCSC has been a MEDecision customer since 1994, but decided to acquire MEDecision in a $121 million deal to have a competitive edge, even though MEDecision will continue to operate as a wholly owned subsidiary, still selling its products to other insurers and health plans, said Bill Gerardi, HCSC executive medical director.
"We are investing in technology that supports our relationship with physicians, provides them with meaningful information for the care of our members without disrupting [the doctors'] processes," said Gerardi.
MEDecision's collaborative care and disease management software analyzes patient claims and other data to help identify members with the highest risk of developing serious medical issues so those patients can be directed to preventative treatment.
Based on data such as a patient's prescriptions filled or health-care services received, the MEDecision software helps insurers and health-plan care managers identify high-risk patients who should be encouraged to get follow-up care or other treatments to avoid the risk of disease side-effects, said MEDecision CEO David St. Clair. The health-plan care managers then provide outreach services to those members -- for instance, urging high-risk diabetic patients about preventative care they should seek to prevent vision problems or heart disease.
However, to make a bigger impact in improving the health of its members, as well as reduce health-care costs related to preventable complications of chronic illnesses, HCSC wants to get the patients' doctors more proactively involved in programs for high-risk patients.
It's estimated that fewer than 20% of the nation's doctors have installed electronic health record systems in their offices, but through MEDecision's tools, "in the simplest form," a doctor can print out a PDF recommending best-practice care information from the insurer when the physician's staff does routine insurance eligibility checks of patients.
MEDecision also has a relationship with E-medical record vendor NexGen to transmit this type of information into NexGen digital medical records, and is looking to offer "lots of ways to support doctors" in getting this information, said St. Clair.
The company is also evaluating whether to financially reward doctors who, for instance, also use MEDecision tools to help identify their own high-risk patients and provide wellness and preventative care based on medical best-practices.
For instance, "there are a lot of metrics out there," showing that heart attack patients benefit from being on beta blocker drugs, said Gerardi. But three months after a heart attack, some patients who should be on beta blocker drugs aren't, he said.