Harnessing the Power of Data to Reduce Healthcare Waste

Harnessing the Power of Data to Reduce Healthcare Waste

By Bob Kolodgy, Executive Vice President & Chief Financial Officer, Blue Cross Blue Shield Association

Bob Kolodgy, Executive Vice President & Chief Financial Officer, Blue Cross Blue Shield Association

Secure, accurate data is crucial to a well-functioning, affordable healthcare system. When waste creeps into the healthcare system, affordability is threatened. Currently, one quarter of the total healthcare costs are due to waste in the form of inefficiency, excessive pricing, care delivery failures, over treatment or low value treatment, care coordination failures, and fraud.

Blue Cross and Blue Shield (BCBS) companies—as insurers of one-in-three Americans and guardians of the largest insured member health information repository—are using data insights to reduce waste and applying the latest technologies to lower healthcare costs.

Championing Interoperability

One way BCBS companies are reducing healthcare costs is by empowering consumers through interoperability. Interoperability allows the healthcare ecosystem to exchange data in a common language, making it easier for consumers to access and share their healthcare data when and where they need it. Putting health records back into the hands of our members gives them control of their health history and reduces the likelihood that future treatment will be inappropriate or duplicative.

Building upon the CMS Blue Button initiative—an online system for patients to view and download their own personal health information—our companies have been leading proponents of Blue Button 2.0, a platform where Medicare Advantage plan members can securely access their personal health data online or through mobile apps using HL7’s FHIR API format.

The majority of health mobile apps available today do not always provide the security and privacy consumers deserve. Third-party health applications are not always subject to Health Insurance Portability and Accountability Act (HIPAA) privacy protections, allowing the apps to share data—sometimes without a consumer’s knowledge. BCBS companies, as insurers, must follow HIPAA’s privacy and security requirements surrounding personal health information and ensure that any transactions containing member data remain compliant with federal privacy and security standards.

Combatting Fraud and Abuse

Another way we protect consumer’s health data is through robust internal security measures. Healthcare companies experience multiple types of fraud including consumer fraud, provider fraud, and information security intrusions. These fraud patterns are well established, and big data analytics help us find fraud patterns and shut them down.

More recently, with the variety of ways our information can be misused and drive up healthcare costs, it is crucial to identify threats. We defend our data through dedicated teams who monitor for external and internal security threats to ensure we are equipped with the latest intelligence and tools to respond to incidents swiftly. Through diligent monitoring to identify threats, our teams ensure our members’ data is out of reach from bad guys who seek to defraud the healthcare system.

Collaborating to Apply New Technologies

This year, we established a coalition of six BCBS companies working to increase provider data accuracy by using blockchain technology, which could reduce inefficiencies in the healthcare system by hundreds of millions of dollars annually. Blockchain can provide unprecedented levels of transparency and integrity to health transactions. As this coalition continues its work, we will be testing this application and exploring options to scale and extend it to more BCBS companies.

Our efforts to use and protect data to effectively lower healthcare costs supports our over arching belief that everyone should have access to high quality and affordable healthcare no matter who you are or where you live. As leaders in the healthcare industry, we are continuing to pave the path to a better healthcare system—for the health of America.

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