Blue Cross and Blue Shield of Louisiana is implementing the Specialty Care Insight program, making information about cost and quality more transparent to specialty providers in our network.
Blue Cross will give physicians in certain specialties data that can help them identify effective strategies to reduce use of low-value, high-cost services where they may exist, while assessing quality-of-care metrics.
Providers who have questions about this program can contact Blue Provider Relations at email@example.com or 1-800-716-2299, option 4.
More than ever before, customers are struggling to deal with the soaring costs of healthcare and their personal out-of-pocket medical costs. As such, they are asking for credible information on the cost and quality of healthcare services across Louisiana.
And while many people believe that “more care is better care” and that more expensive care is higher-quality care, we know the opposite is true. Those doctors and practices that produce the best outcomes tend to do so at lower costs.
To address this, Blue Cross is collaborating closely with the providers in our network to drive high-quality healthcare while lowering overall costs.
Blue Cross has access to large amounts of data through our claims, which we are now able to analyze with sophisticated tools to give providers deep insights on the efficiency and effectiveness of care at both a medical condition and full-care episode level.
We have partnered with Cave Consulting Group, Inc. (CCGroup) to share this information with our network providers in certain specialties through our new Specialty Care Insight reports. CCGroup, Inc. is an independent company that provides analytical tools for Blue Cross and Blue Shield of Louisiana and its subsidiaries.
CCGroup has developed an analytics tool that can generate practice-level reports on several important attributes that may help a practice identify overuse of low-value, high-cost services, and reduce these instances to drive use of high-value, cost-effective services. The analytics also help identify underuse of potentially beneficial, high-value services so that practices may review their patterns of care delivery.
SCI Target Specialties
Blue Cross will engage at least four specialties in this program in 2014. The first two specialties that will receive Specialty Care Insight Reports are cardiology and orthopedic groups in the Blue Cross network.
Later in 2014, Blue Cross will select additional specialty groups to include, likely choosing from among gastroenterology, ear/nose/throat, obstetrics/gynecology, urology and/or neurosurgery/spine surgeons. After the initial year, more specialty types may be included.
Blue Cross will conduct training to help the participating specialty groups understand the reports. Live webinars will be offered for eligible providers in each region and specialty selected, to explain the need to create this program, and how providers can glean actionable data from their reports.
Each practice’s Specialty Care Insight Report will:
Please see the 2015 How to Read Your Specialty Care Insight Report guide for more information.
Practices are strongly advised to view the SCI program videos to gain a better understanding of their reports.
The report’s data is unique in our market, in that the targeted specialties can see their impact relative to their peers across the entire care spectrum for medical conditions most commonly treated by that specialty.
See Frequently Asked Questions about the Specialty Care Insight Report and examples of medical conditions by specialty for:
The Specialty Care Insight program held live webinars with providers to describe the program in further detail, discuss how providers can read their Specialty Care Insight reports and use the data included, and address any questions from providers.