Blue Cross & Blue Shield of Rhode Island recently welcomed Chief Data and Analytics Officer Amar Gurivireddygari to its team.
Tasked with making the health care insurer’s technology better match its strategy, the role is not a new one at Blue Cross. It is, however, an evolving one, as the industry moves away from a fee-for-service model of payments to providers.
Now, patient experience and costs are front and center.
“We’ve doubled down with our focus on providing health management, helping providers take more risk,” said Mark Stewart, Blue Cross’ chief financial officer. “Moving away from fee for service means more of, ‘How do we manage patients better … so that when [they] go for procedures they are at the highest-quality institution with the lowest cost?’ ”
And here is where data and analytics come to the rescue.
Zach Sherman, director of HealthSource RI, agrees data is crucial to reaching more people with higher-quality, more-affordable health coverage. “We regularly track and report on customer-service metrics to identify and work through operational barriers to access,” he said.
Examining patterns within large datasets is where health care is headed. A 2017 survey by the Society of Actuaries shows that 93% of health care organizations say predictive analytics are important to the future of their businesses. More than one-quarter of respondents expected big-data analytics tools to save them 25% or more on costs over the next five years. About 47% of providers and 63% of payers already had invested in predictive-analytics tools.
‘[ZIP codes] can be more of a determinant of health than genes.’
Mark Stewart, Blue Cross & Blue Shield of Rhode Island chief financial officer
For its part, Blue Cross is strategic regarding not only the use of data but also who it has chosen to do so.
Gurivireddygari has experience in managed-care transformation, population health management, clinical informatics and disease management, says Blue Cross, coming to Rhode Island from a provider-owned health plan in Maryland, MedStar Family Choice.
“You can find a data scientist who may be good at analytical aspects, but it can be tough to turn theory into practice,” Stewart noted. “It calls for a strategic mindset. … [Should we] invest this way?”
With Gurivireddygari on board, improved systems of care are being implemented, offering a more-complete scope of a patient’s care and better communication, he says.
“We are working to integrate,” he added. “Now, in health care, when we get financial data on a claim, it’s the date and time. [It] doesn’t speak much on lab work, immunizations, do they have high cholesterol, low cholesterol, have they been given Lipitor? One medication can cost $2 versus $90.”
But more-comprehensive information means gaps in care would be better defined and could be addressed in whichever way proves most effective.
Another bonus – in addition to Gurivireddygari’s broad experience – is the strong relationships with physicians and other partners that the insurer has nurtured. Provider partners are as committed to proactive change as Blue Cross, said Stewart.
He also said that the insurer’s local presence can make all the difference when it comes to disease and its factors.
“We understand ZIP codes,” he said. “Those can be more of a determinant of health than genes,” with insight into housing factors or food deserts that are causing health issues, for example, oftentimes resulting in more prescriptions written and more use of the emergency room in certain areas.
This local presence also allows for more partnerships. “Investments can be aligned to solve community-based problems,” said Stewart.
For example, Blue Cross is partnering with Providence’s Oak Street Health, which specializes in value-based care, spending time with patients and explaining their conditions – very likely cutting costs in the process.
HealthSource RI says data offers access that’s difficult to obtain any other way. “We leverage survey data to identify and market to the uninsured – which with less than 4% of the state without health insurance is a hard-to-reach population,” noted Sherman.
For now, Gurivireddygari has been listening and learning. He’s looking for gaps, before beginning technology planning for the long term.
The insurer already is working with providers in an exploratory phase for a blockchain pilot program. Blockchain’s distributed databases provide transparency, security, efficiency and cost benefits, innovation Stewart is excited about. He anticipates blockchain at Blue Cross in two to three years.
More than just aggregating data, said Gurivireddygari, the Blue Cross mission is about figuring out how quickly it can close gaps and ensure that better outcomes are the result for patients.
“The whole health care entity is learning the value of interpreting data and putting it into action,” said Gurivireddygari. “Blue Cross is heading in the right direction with conviction.”
