Insurer Says Technology Acquisition To Transform Patient CareInsurer Says Technology Acquisition To Transform Patient Care

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. 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.