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Capital BlueCross Value-Based Partnerships Lead to Continuous Quality Improvement

Geneia Innovations Drive Significant HEDIS® Improvements

Harrisburg, Pa – Capital BlueCross today released results demonstrating its value-based partnerships, including its Quality First Accountable Care Arrangements, are leading to continuous improvement in the quality of health care for customers. From December 2015 to November 2016, the company’s accountable care partners markedly outperformed their fee-for-service peers in 19 of 25 tracked Healthcare Effectiveness Data and Information Set (HEDIS®) measures. They include:

  • Breast cancer screenings
  • Cervical cancer screenings
  • Colorectal cancer screenings
  • Childhood immunization status
  • Comprehensive diabetes care (HbA1c testing and attention to nephropathy)

HEDIS® is a comprehensive tool used by most health plans to measure performance on important aspects of care and service.

Capital BlueCross was the first health insurer to introduce Accountable Care Arrangements (ACAs) in Central Pennsylvania and the Lehigh Valley. The company launched its first partnership in 2011. Accountable Care Arrangements foster a collaborative approach between Capital BlueCross and participating providers, leading to more coordinated patient care, improved health outcomes and reduced costs. Today, more than 2,800 physicians and 362,000 customers participate in Capital BlueCross’ ACAs.

“Capital BlueCross’ value-based partnerships are improving the quality and cost of care, just as we intended. We are emphasizing the delivery of preventive services appropriate to a member’s age and health status, while intervening earlier with targeted care management resources for at-risk and chronically-ill members,” said Dr. Jennifer Chambers, Capital BlueCross senior vice president and chief medical officer. “With Geneia, we’ve been able to offer even more support to our ACA partners through dedicated care management resources and technology, leading to significant improvement in our HEDIS® performance and even better health care for our customers.”

Through its relationship with Geneia, an analytics and technology leader in transforming health care delivery, Capital BlueCross provides integral support to its ACA providers, including:

  • Deploying Geneia’s Theon® advanced analytics and insights platform to ACA providers, which integrates a new way to display, process and address member care gaps into the existing clinician workflow.
  • Assigning population health consultants and hosting regular population health meetings with physician leadership.
  • Delivering care coordination, care management and member outreach through the clinical innovation team.

“Advocating for quality care is only achievable when our clinical providers and our payer partners work together. The exchange of timely and meaningful information through the use of tools like the Theon® platform enable PinnacleHealth and Capital BlueCross to better understand the health care needs of the people we serve,” states Robert Nielsen, president, PinnacleHealth Medical Group. “We have been able to actively identify higher risk patients, often with multiple morbidities, and facilitate the implementation of an effective plan of care.”

About Capital BlueCross

Capital BlueCross, headquartered in Harrisburg, Pa., is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. A partner in the community’s health for nearly 80 years, Capital BlueCross offers health insurance products, services and technology solutions that provide peace of mind to consumers and promote health and wellness for our customers.

More than a health insurer, the company delivers innovative solutions through a family of diversified businesses that is creating a healthier future and lowering health care costs. Among these solutions are patient-focused care models, leading-edge data analytics, and digital health technologies. Additionally, Capital BlueCross is growing a network of Capital Blue stores that provide in-person service and inspiration to help people reach their health goals. Capital BlueCross is an independent licensee of the BlueCross BlueShield Association.

About Geneia

Geneia LLC specializes in the development of advanced clinical, analytics and technical solutions for healthcare transformation. Our team of physicians, nurses, technologists, analytics experts, and business professionals have created a suite of solutions that enable health plans, hospitals and employers to better understand, evaluate and manage the health of their populations. Using our advanced analytics platform, remote patient monitoring tool, and education and research institute, we work with healthcare organizations to improve outcomes, lower costs and restore the Joy of Medicine. The company has offices in Harrisburg, PA, Manchester, NH, and Nashville, TN. To learn more, visit Geneia online or connect with us Twitter and LinkedIn.

HEDIS consists of 71 measures across eight domains of care.

HEDIS measures address a range of health issues including: asthma medication use; persistence of beta-blocker treatment after a heart attack; controlling high blood pressure; comprehensive diabetes care; breast cancer screening; antidepressant medication management; immunization status; and advising smokers to quit.