Blue Cross of Idaho (“BCI”) was focused on improving affordability for its members and customers. Their Healthcare Economics Division had identified the need to complete a baseline evaluation of over 50 initiatives across a range of use cases. However, their capacity to complete the analysis averaged one program per month – thus projecting a requirement of over 4 years to complete their work. Additionally, the team wanted to provide a granular level of reporting on each initiative across a variety of key performance indicators such as net paid claims savings, drivers of consumer behavior by cohort, utilization, cost, impacts on utilization of alternative care settings, etc.  

By leveraging the NextHealth platform, BCI was able to “leapfrog” its capability to conduct the evaluation process and assessed all 50+ programs in six months. In addition to establishing essential baselines, the plan gained:

  • Trust in the data by using an analytically rigorous program setup and methodologies  
  • A platform for data sharing – expediting communications with stakeholders  
  • Data-backed reports leverage with customers, brokers and sales teams – facilitating a market advantage and opportunity to propel business growth

The first step toward affordability – knowing what works – with the advanced breadth, depth and speed of the NextHealth platform, is key to plans understanding what they have, what they need to look at, and where to go from there.  

Drew Hobby, Senior Vice President of Healthcare Economics at Blue Cross of Idaho, recently shared some of his company’s best practices in a webinar hosted by NextHealth. What follows are the 5 steps he outlined in moving to improved affordability.

We have to move quickly. We only have so many resources at Blue Cross of Idaho, and it’s critical that we are allocating them in the exact right way and getting the most value out of those resources.” 

Step 1: Start with a baseline 

Prior to NextHealth, Blue Cross of Idaho was evaluating one clinical program a month. At that pace, it would have taken them four years to complete a baseline analysis of all of their initiatives. But by leveraging NextHealth’s advanced analytics platform, the plan measured 50+ programs in just six months with a level of granularity that allowed them to prioritize their affordability efforts.   

“A lot of folks have access to data and can do analytics. That’s very different than actually executing and taking actions that drive medical expense reduction for your customers.” 

Step 2: Establish a governance structure to support fast, data-driven decisions  

In response to client demand, Blue Cross of Idaho implemented a new operating model dedicated to reducing healthcare costs for customers by capitalizing on data insights. Establishing a Healthcare Economics Division consisting of an Analytics group and a Healthcare Solutions team ensured integration with the business needs, data-driven insights, and a way to move those insights rapidly into workflow.   

“We earn a lot of value in telling customers about programs that are driving positive results and equally, programs that are not. And then, ‘Here’s why,’” 

 Step 3: Uncover insights with a wide array of key performance indicators 

Know what is working and what is not beyond the total cost of care by including a wide variety of additional KPIs to evaluate within a program. NextHealth’s platform with its ability to craft custom KPIs makes it easy to achieve highly granular studies to generate actionable insights and uncover previously unseen opportunities to further impact cost reduction. This deep level of understanding allows plans to articulate whether a solution is working and where there is opportunity to improve. 

“NextHealth was huge in helping us feel very comfortable with the propensity score and the matching of comparing cohorts…which makes us really comfortable with calculating the ROI. If we are sitting down in front of a large account, we need to be very confident with the integrity of the case study.” 

Step 4: Utilize trustworthy results to build customer relationships 

Organizational trust in analytic reporting is not always a given. But the methodological rigor embedded in the NextHealth platform (for example, propensity score matching and over 300 covariates to select comparative cohorts), instills confidence in the study results and thus earns greater credibility with health plan employer customers. The platform puts rapid, actionable, credible data in plan executives’ hands, enabling them to demonstrate value to their customers in the most compelling way 

“We can continuously measure all existing and new solutions every month in perpetuity. NextHealth allows us to do it rapidly and with integrity so our team can spend time focused on what’s driving solutions instead of digging for data.” 

Step 5: Measure repeatedly to drive optimization

NextHealth’s scalable platform stands alone in its delivery of speed, scale, and granularity. That means that valuable resources formerly spent on data analysis can be more productively focused on evaluating results, solutions and program design. Programs can be evaluated continually, producing metrics for future program design. Solutions can be designed and measured using very specific inputs and forecast from a medical expense improvement standpoint that flows all the way though the value chain. Determining which solutions are working and whether there is additional opportunity drives ongoing expense reduction, and the NextHealth platform means it’s all available in real time.  

The NextHealth platform empowers health plans with unique capabilities to measure all of their clinical programs in a comprehensive and efficient manner, and then use the results to further investigate and drive affordability efforts. Blue Cross of Idaho was able to radically speed up their program evaluation and focus their attention on what mattered most – improving affordability and improving outcomes. To learn more, please contact us.