Blue Cross Uses Claims Data to Improve Hospital Practices, Costs


tHospitals across Michigan will be able to compare their practice patterns with their peers thanks to the Blue Cross Blue Shield’s Collaborative Quality Initiatives program, which was announced on Tuesday. So far, the effort has saved hundreds of millions of dollars in health care costs by improving the effectiveness and efficiency of medical and surgical procedures.

tAbout 330 hospital representatives attended the first meeting for the Michigan Value Collaborative — a project between Blue Cross Blue Shield of Michigan, Blue Care Network, and the University of Michigan Health System — last week. There, the hospitals received the first reports concerning their performance with heart attacks, congestive heart failure, cardiac surgery, hip replacement, and colon surgery. 

tThe reports compare hospitals on cost and variation based on claims data from BCBSM, and soon, Medicare. They show their comparative costs during hospital admissions and for care delivered before and after hospitalization. For instance, claims data showed that payments for congestive heart failure ranged from $20,743 to $33,549, with the average episode procedure was priced at $27,973. A total hip replacement ranged from $27,113 to $34,578, and averaged $29,611.

t“This initiative is unique in that it allows participating hospitals to see how they compare with other hospitals, and how they can use that data to better connect their care practices and costs with outcomes,” says David Share, senior vice president of value partnerships at BCBSM. “Hospitals will be able to adjust their practice patterns to benefit patients and the overall efficiency of our health care system."

tThe database platform and analytics was provided by ArborMetrix, an Ann-Arbor based technology company founded by Dr. John Birkmeyer and two others. Birkmeyer and other faculty with the University of Michigan Center for Healthcare Outcomes and Policy will lead the program and its coordinating center. 

t“Providing hospitals with reliable feedback on their comparative costs is obviously important in the era of health reform,” Birkmeyer said in a statement. “We also want to give them insights about how they can help their patients achieve the best possible outcomes at the lowest reasonable cost.”

tIn the future, participating hospitals will receive data for several clinical conditions and procedures. Initially, the MVC will focus on procedures and conditions that are among the most common and costly — and often associated with wide variations in treatment.