Question 3 for Chapter 3:

Transcription

1 Taylor C. Veillon Blue Cross and Blue Shield Question 3 for Chapter 3: The Blue Cross and Blue Shield Association (BCBS) is a national federation of 37 independent and locally operated companies, offering a local, need-based approach to healthcare. Some of the association s networks and systems operate together, but independent branches pursue their own information system projects as well. For discussion of the process used to manage an information systems project, CareFirst BlueCross Blue Shield (CareFirst BCBS), the BCBS branch in Maryland, will be used as an example. At CareFirst BCBS, the initiation phase quickly transitions to planning. Project goals and priorities of management are determined through collaboration between program managers, project managers, and project sponsors. This involves creating the planning documentation, following CareFirst project methodologies, such as discovery documents and charters, and publishing clear priorities among the project s different activities to yield a business plan that parallels the strategic plan, operating budget, and agency guidance. Sponsors and stakeholders are also consulted to develop a cost/benefit case for management approval. Business analysis is also used to ensure that the organization is prepared for the project implementation by evaluating operational readiness. As the project moves into execution, a technical operation support manager would help coordinate the project team s activities to meet set milestones. Updates are made to the plan as needed. Once the project has reached a mature stage of completion, team leaders and members discuss progress with top management to ensure objectives are met, project has fulfilled expectations, and progress is sustainable. Wellmark Blue Cross and Blue Shield provides coverage for both Iowa and South Dakota and has a moderately specialized approach to how it handles information systems project management. At Wellmark, the information systems and project management needs are handled by one team/division, Business Technology Services (BTS). BTS collaborates with the different business departments within the company to define, provide, support, and maintain needed applications, tools, and infrastructure. This division is designed with the purpose to enable the company to better serve members. Corporate projects and proposed initiatives are managed and carried out by BTS teams with staff from multiple disciplines. These teams include technical analysts, business analysts, developers, technical architects, and project managers. Another example that will yield understanding of the professionals needed to effectively and efficiently handle initiatives within the company is the practice used at Arkansas s BCBS affiliate. At Arkansas BCBS, a project management (PM) analyst facilitates any future developments of the Enterprise Project Management Office (EMPO). Skills needed for this position include knowledge and experience with project management methodologies and at least a basic understanding of information technology and its applications in business. The PM Analyst must also have strong organization and communication skills coupled with a willingness to learn and understand other aspects of the company. These skills will allow the analyst to coordinate schedules, promote collaboration between different business areas when enterprise projects are needed, and understand the specific needs within different divisions when projects become more complex and limited to a certain department. Blue Cross Blue Shield of Michigan s Project Manager position falls under the Product and Process Improvement division. A needed skill listed within this area is experience with project management software. Unfortunately, BCBS Michigan and the other affiliates do not provide information about what specific software system they use for project management. However, with a solid understanding of the industry BCBS affiliates operate in, one could 1

2 assume that the project management system would have to be very adaptable to different needs and allow collaboration across departments and between professionals with different expertise (consultant doctors, regulation analysts, and information technology analysts). These characteristics would yield effective management of projects designed to improve business practices within the company, improve services provided to members, and enhance healthcare through collaboration with facilities and physicians. Some of the best practices within the healthcare insurance industry, as stated by PricewaterhouseCoopers, include the effective use of data analytics as well as enhancing healthcare operations with technology. The public sector of health care is focusing on creating and executing plans to streamline the use of electronic medical records as well as utilizing personal mobile technologies to empower providers with information on clinical outcomes, patient preferences, and service delivery. Technology is being strategically utilized to provide members care anywhere. Efforts to enhance the management of chronic illnesses are being intertwined with technology-dependent business models. The use of telecommunications and mobile health companies are extending availability of chronic care to the poorest of populations. Blue Cross and Blue Shield companies optimize the use of information technology to achieve best practices for their industry. Aligning with PwC s findings of best practices, BCBS exploits the growing popularity of mobile healthcare with its applications such as GeoBlue and Blue National Doctor and Hospital Finder. Another example of their commitment to best practices is the Blue Distinction program which identifies excellent care facilities for members, benefitting members with better healthcare networks and benefitting healthcare providers by showcasing their expertise. Blue Cross and Blue Shield affiliates should continue to develop their technological connection to both physicians and members. With easy-to-use websites and mobile applications, BCBS would likely see an increase in consumer awareness and satisfaction. Question 4 for Chapter 4: With an external view of the healthcare insurance industry, projects are identified as needs or problems arise, and information systems are utilized to streamline processes and resolve issues, hopefully yielding the main objective: improved health of BCBS members. One example of a perceived need being combatted with software was when BCBSLA noted the rising trend in healthcare-associated infections (HAI s) and developed an initiative to determine the reasons why. Blue Cross and Blue Shield of Louisiana teamed up with CareFusion MedMined Services with the goal to reduce infection rates in hospitals by using state-of-the-art data mining techniques specifically designed for the task at hand. MedMined provides software that can review billions of patterns of hospital/patient interactions to identify causes of infections, develop preventative measures, and avoid deviation from decided upon best practices. Another method for project selection is investment in perceived opportunities to improve business. Blue Cross Blue Shield of Massachusetts foundation awarded over $575,000 to four different organizations to conduct research focused on health care costs. Cost containment, which is the initiative to make health care more affordable, could help BCBS Massachusetts improve their bottom line by cutting their own costs as well as expand their market share with the addition of new customers who were previously unable to afford major medical health insurance. The latest program launched by Blue Cross and Blue Shield s Louisiana-based affiliate is Quality Blue Value Partnerships. It recognizes the shift from traditional fee-for-service models to valuebased and cost effective care. The primary goal of the Quality Blue family of programs is to improve patient health outcomes and keep members costs in line. 2

3 Within information systems planning, an organization analyzes the current state of operations, determines the level at which it should be operating at a point in the future, and develops a plan to strategically get from the current situation to the ideal future situation. An example of implementation of part of a strategic information systems plan is the creation of the Advanced Health Information Network (AHIN) by Blue Cross and Blue Shield s Arkansas affiliate. After recognizing the need for an integrated claims processing, communication transaction, and health care delivery system, Arkansas BCBS created the Advanced Health Information Network (AHIN). AHIN enabled hospitals to be connected to their physicians, physicians to be connected to other facility physicians, and physicians to be connected to employers and payers. AHIN works by linking Arkansas BCBS information systems, providing access to eligibility information, remittance advice, claims, claim status, detail reporting capabilities, and fee schedules all at the same time. The functionality includes real-time correction of incorrect claims and electronic claims submission. By using internet-based technology, all programs necessary to access AHIN are present on most personal computers, so that no purchase or installation of software is needed. Some projects are identified outside of the planning process as needs arise, but the majority of internal, operations-related projects stem from the analysis of the company s current level of operations, what level it would like to be operating at in the future, and how it plans to achieve that improvement. Blue Cross and Blue Shield Association affiliates aim to lower their own costs while improving overall care and health outcomes for members. The corporate strategic planning that identifies these objectives from an enterprise-wide perspective parallels the information systems planning that yields achievement of these goals. For instance, Blue Health Intelligence (BHI) leverages Blue data, the healthcare experience of more than 110 million individuals across the nation, with the goal to improve the delivery of care. BHI uses advanced analytics and applied research studies to reduce medical costs, increase efficiency of operations, support engagement with members, and improve network management. Another example is Quality Blue Primary Care, a program in the Quality Blue family, which benefits patients with chronic conditions by allowing doctors to share information efficiently and to identify gaps in care provided. With the addition of the partnerships program, larger provider systems can now expand beyond primary care to examine patient experiences within their entire system. To provide the analytical and technical support needed for the program, Blue Cross is paying for access to the online TREO Solutions dashboard for each of its enrolled systems. TREO is allowing administrators to review claims data to identify better uses for resources, conduct better outreach activities, and change practice patterns. The Blue365 Program is another example of an initiative that reflects BCBS s corporate strategic planning goals and has been implemented by 23 of the 37 affiliates. The program is designed to encourage members to make healthy choices, help members save money, and in the long run, save BCBS money by producing healthier members. The Blue365 Deals are discounts on products and services that contribute to a well-balanced lifestyle. Some of the best practices within the healthcare insurance industry, as stated by PricewaterhouseCoopers, include the effective use of data analytics and measurement as well as enhancing care operations with technology. The public sector of health care is focusing on creating and executing plans to streamline the use of electronic medical records as well as utilizing personal mobile technologies to empower providers with information on clinical outcomes, patient preferences, and service delivery. Technology is being strategically used to provide patients care anywhere. Efforts to enhance the management of chronic illnesses are being intertwined with technology-dependent business models. The use of telecommunications 3

4 and mobile health companies are extending availability of chronic care to the poorest of populations. Blue Cross and Blue Shield companies optimize the use of information technology to achieve best practices for their industry. Aligning with PwC s findings of best practices, BCBS exploits the growing popularity of mobile healthcare with its applications such as GeoBlue and Blue National Doctor and Hospital Finder. Another example of their commitment to best practices is the Blue Distinction program which identifies excellent care facilities for members, benefitting members with better healthcare networks and benefitting healthcare providers by showcasing their expertise. Blue Cross and Blue Shield affiliates should continue to develop their technological connection to both physicians and members. With easy-to-use websites and mobile applications, BCBS would likely see an increase in consumer awareness and satisfaction. 4

5 Works Cited "Advanced Health Information Network." AHIN - Arkansas Blue Cross and Blue Shield. Arkansas Blue Cross and Blue Shield, n.d. Web. 4 Oct "Blue365 Healthy Deals." Blue365 Health and Wellness Deals and Discounts Exclusive to Blue Cross and Blue Shield Members. Blue Cross and Blue Shield Association, n.d. Web. 4 Oct "Blue Cross and Blue Shield of Louisiana Launches Quality Blue Value Partnerships to Engage More Providers." Media Center. BlueCross BlueShield of Louisiana, 22 July Web. 4 Oct "Blue Cross and Blue Shield of Louisiana Strongly Supports Federal Efforts to Reduce Harmful Medical Errors." BlueCross BlueShield of Louisiana. BlueCross BlueShield of Louisiana, n.d. Web. 4 Oct "Blue Facts: Healthcare Coverage Designed For Your Community, Accessible Across The Country." Blue Facts of the Blue Cross and Blue Shield Association and Blue System. BlueCross BlueShield Association, n.d. Web. 3 Oct "Career Areas at Wellmark." Wellmark Blue Cross and Blue Shield. Wellmark Inc., n.d. Web. 04 Oct "Global Healthcare Case Studies and Best Practices." PwC. PricewaterhouseCoopers, n.d. Web. 3 Oct Lichtenstein, Marc. "Best Practices for Transforming Healthcare." BlueCross BlueShield Blog. Blue Cross and Blue Shield Association, n.d. Web. 5 Oct "Project Management Analyst." Career Opportunities - Arkansas BlueCross BlueShield. Arkansas Blue Cross and Blue Shield, n.d. Web. 5 Oct

6 "Technical Operation Support Project Manager." LinkedIn. CareFirst BlueCross BlueShield, n.d. Web. 3 Oct