BCBS utilizes price transparency data for healthcare insights, enhancing value-based care and system-wide improvements. Blue Health Intelligence collaborates with 17 affiliates, employing disclosed rates and comparison tools since 2022. CEO Bob Darin emphasizes data’s role in identifying care patterns, focusing on quality outcomes. Challenges lie in evolving reimbursement systems, leveraging regulatory changes, and empowering consumers with actionable pricing data.
BCBS leverages price transparency data for healthcare advancements. Blue Health Intelligence, owned by 17 BCBS affiliates, has harnessed disclosed rates and comparison tools since 2022. CEO Bob Darin highlights data’s significance in pinpointing care patterns and elevating quality outcomes. Challenges encompass reshaping reimbursement structures, adapting to regulatory shifts, and empowering consumers with actionable pricing insights.
The driving force behind much of this initiative is Blue Health Intelligence (BHI), the analytics and data division of the BCBS Association collectively owned by 17 BCBS affiliates. Becker’s had a conversation with BHI CEO Bob Darin, exploring how BCBS plans nationwide are utilizing price transparency data and the key challenges that persist.
Since July 2022, payers have been obligated to unveil in-network provider rates, out-of-network allowed amounts, billed charges, negotiated rates, and historical net prices for covered prescription drugs administered by providers. Additionally, from 2023 onwards, payers were required to furnish an internet-based price comparison tool for 500 items and services, encompassing all services, including prescription drugs.
Q: What has been the primary focus of your efforts as CEO over the last year?
Bob Darin: We’ve been dedicated to leveraging data to address emerging healthcare issues. One critical area we’ve focused on is advancing value-based care delivery. Through our data, we’ve collaborated across the healthcare system to pinpoint areas achieving superior outcomes: efficiently treating individuals, reducing hospital readmissions, and lowering costs. For the first time, we’re partnering with every Blue Cross plan nationwide to identify care patterns demonstrating exceptional quality across various physician specialties. It’s an exciting venture, and we’re optimistic about uncovering more insights into what drives better care outcomes for patients.
Q: What market challenges or predictions do you anticipate shaping the landscape based on the data you’ve examined?
BD: The ongoing emphasis remains on revamping the reimbursement system, transitioning towards valuing outcomes over the quantity of services provided. While it’s a prolonged journey discussed for decades, it’s gaining significant traction.
We also see opportunities stemming from regulatory changes in recent years, notably interoperability and price transparency. Accessing data previously confined within physician electronic medical systems through interoperability regulations opens new avenues. Clinical data is becoming part of payment systems, influencing quality measurement and the management of at-risk populations. There’s extensive ongoing work in this realm, and we’re building systems to accommodate this influx of data.
Regarding price transparency, we’re actively using published data within the Blue Cross system, simplifying its complexity to aid decision-making. We’ve developed a robust system to comprehend trends and variations in this public transparency data, empowering Blues plans to make informed market decisions.
Q: How are you assisting consumers in leveraging this pricing data?
BD: Standardizing data and cross-referencing it against other reliable sources has been our concerted effort. By matching Blues system data with that from other payers and hospitals, patterns emerge, offering insights into market dynamics and local contract negotiations. Advanced plans have begun acting upon these insights.
Consumer accessibility to these insights remains a work in progress. The original expectation of easy price comparison and shopping for services hasn’t materialized due to the complexity of healthcare journeys. However, ongoing pilots aim to integrate this data meaningfully for consumers. The journey towards transparent consumer information is underway, albeit it may take time to fully materialize.
BCBS’s utilization of price transparency data drives healthcare improvements. Blue Health Intelligence’s collaboration with 17 affiliates harnesses disclosed rates and comparison tools. CEO Bob Darin stresses data’s pivotal role in identifying care patterns and improving quality outcomes. Challenges revolve around transforming reimbursement systems, leveraging regulatory changes, and empowering consumers with actionable pricing data for informed decisions. The journey toward transparent consumer information continues, promising a revolution in healthcare accessibility and value.