BlueCross BlueShield of Tennessee: Breaking Barriers
Insurance
Written by Amanda Gaines   
Thursday, 31 January 2008
BlueCross BlueShield of Tennessee: Breaking Barriers - Health Executive - RedCoat Publishing
Vicky Gregg describes how this health plan is improving the lives of more than just its customers.

Tennessee’s ranking as 46 out of 50 in overall health status is a daunting figure. Thankfully, Vicky Gregg, president and CEO of BlueCross BlueShield of Tennessee, is energized—not overwhelmed—by this figure. By tackling the state’s healthcare issues with an impartial eye, she and her team have started breaking down the barriers that often prevent these statistics from improving.

“Healthcare is still very much a cottage industry,” said Gregg. “There are structural barriers preventing the change I believe everyone in the system wants. When you dive into it, you have to be prepared to take some risks and recognize you will encounter successes and failures.”

BlueCross BlueShield of Tennessee: Breaking Barriers - Health Executive - RedCoat Publishing
Vicky Gregg, President and CEO
Facing a state in which the incidence of diabetes, cancer, and heart disease is higher than most states, coupled with a high teen-pregnancy rate and zip codes in the Memphis area with higher rates of infant morbidity and mortality than some third-world countries, Gregg and her constituents faced an uphill battle. It also led Gregg and her board to look at possible solutions in a slightly unconventional light.

As a single-state Blue plan, BlueCross BlueShield of Tennessee has high marketshare and retention, which makes it capable of investing in initiatives. In 2004, for example, the company began funding the Blues Project, a clinic- and home-based social intervention program focused on providing assistance for at-risk mothers and their babies across the region. Early results of the first phase of the program, which started in May 2004 and ended in December 2006, showed a reduced infancy mortality rate, as well as improved social outcomes for the mothers. Phase II is currently underway.

2005 brought the acquisition of Gordian Health Solutions, a Nashville-based health management services provider for mid-sized to large companies across the US. That same year, the company entered into a partnership with the governor of Tennessee to start Cover TN, a program reaching out to small businesses. “We found many of Tennessee’s uninsured are working full time, but their small employers simply can’t afford the coverage,” Gregg said. “When the medical-care cost trends aren’t in sync with the revenues for the program, that’s when the problems start. We’re working to reach out, bring people in, and get them coverage as best we can while trying to manage the cost structure.”

Beyond the borders
The next step in tackling the state’s health was looking at the entire delivery system and spotting the gaps. Tennessee is no different from other states in the variations in the delivery of care. For example, said Gregg, the chance of getting a coronary artery bypass graft in Memphis is greater than it is in Johnson City, but no statistics show why.

BlueCross BlueShield of Tennessee: Breaking Barriers - Health Executive - RedCoat Publishing
The result of attempting to understand similar variations in Tennessee’s healthcare delivery was the development of Shared Health, an innovative IT solution that provides consumers and clinicians medical information via the Web. A wholly owned subsidiary of BlueCross BlueShield of Tennessee, the integrated solutions provider will enable Gregg to go beyond the borders of BCBS of Tennessee enrollees, touching the population of Tennessee and beyond.

“Our stance is that asking a clinician to do something for a only Blue Cross patients isn’t plausible; when they look at their process and how their offices function, what they do for one they should do for all,” she said. “We looked at Shared Health and said it needs to come from the clinicians’ and patients’ points of view, and it needs to follow them.”

Presenting the Shared Health plan to BlueCross BlueShield of Tennessee’s board was a perfect example of the risk-taking mentality Gregg and her team believe is necessary. “We went to our board, said we needed it to agree to invest in technology that’s not proven and in an approach that’s not proven as a benefit to BlueCross and consumers across the state,” she said. “It was a bold move as a company and as a management team, but our board agreed it made sense and was consistent with our mission and purpose.”

Shared Health was created in a non-proprietary way, populated with administrative data from BlueCross BlueShield of Tennessee. Results from a study published in December 2007 showed a 17% efficiency factor in the physicians who used Shared Health compared to those who didn’t in terms of ETGs (episode treatment groups), which looks at efficiencies in ambulatory visits. Compliance results were also reviewed, for example, with immunizations.

“The immunization rate was 11% higher after Shared Health than before Shared Health,” said Gregg. “It’s also having a significant impact on driving Child Well-Care in the state because parents can go online and enter the data.”

When children come in for a visit, a physician can look at Shared Health and know whether or not they have had immunizations and preventative healthcare treatments. The physician can then check off the child’s record, send it in, and the state can record and get credit for compliance with EPSDT (early and periodic screening, diagnosis, and treatment) in the Medicaid program. According to an actuarial validation report released in August 2007, Shared Health users provided 10.5% more EPSDT wellness services to eligible members and had 30% fewer ED visits, 21% lower-cost visits, and 15% fewer patients needing to be admitted. “The results speak for themselves,” Gregg said.

Multi-specialty culture
Although BlueCross BlueShield of Tennessee is committed to improving the healthcare of residents across the region, it is also committed to improving the health and wellness of its employees. The company is currently spread across 10 locations in Chattanooga, which creates a myriad of inefficiencies, such as employees moving between buildings for tasks as simple as delivering mail.
The new facility, which will move to Chattanooga’s Cameron Hill area, will take up less square footage at 950,000 square feet spread across an integrated five-facility campus, as well as provide an opportunity to upgrade the company’s security. “As a healthcare company, particularly with the emphasis on data and information, having a secure data center is critical but difficult to do in our current configuration,” the CEO said. “Being able to design a data center that’s extremely protected will be an important piece of our move, and as a federal contractor, it’s an essential element of what we have to bring to the table.”

Of equal importance, Gregg views the new campus as an opportunity to transform and mold the culture of the company. The campus will include a path of wellness encouraging employees to be active throughout their workday, and food service is being reevaluated on a cost-effective and health-related basis. “Often in a cafeteria, the cheapest thing is not the healthiest thing,” she said. “We’re trying to change that.”

The new facility will also incorporate areas to make it easier for employees to get basic health screenings, such as blood pressure and cholesterol testing. On the aesthetic side, each employee will have a window view, and for those used to battling their coworkers on the temperature of the office, temperature controls are individualized. “How our workforce feels about where they work directly impacts how they service our customers,” Gregg said. “Our corporate culture is about integrity, honesty, truth, and verification, but it’s also about taking care of our customers, both internally and externally.”

 
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