BCBSNC Using Analytics to Increase Efficiency

Blue Cross Blue Shield of North Carolina (BCBSNC) has selected Prospective Advantage and INDICES by Inovalon, a healthcare technology company, to use analytics based on insurance plans, medical history and other information stored in a data warehouse, in matching patient and provider.

“We know that when care is not well coordinated, it’s less effective and costs more,” says Kat Gesh-Wilson, VP of government operations at BCBSNC. “Inovalon supports our commitment to using data to identify care gaps and support physicians and care providers in helping out customers get well and stay well.”

The integrated solution will help identify gaps between current and desired states of clinical and quality outcomes, risk score accuracy, and care management. The solution uses Medical Outcomes Research for Effectiveness and Economies, a data warehouse by Inovalon, to help predict the right benefits depending on the patient and provider.

Prospective Advantage uses healthcare analytics to coordinate patient and provider. It aggregates administrative, medication prescription and adherence history, diagnostic results, and provider encounter history from the data warehouse, which is owned by Inovalon.

INDICES, a business intelligence and reporting solution, uses data for enrollment, clinical and quality outcomes, cost and utilization, retrospective and prospective risk adjustment and medical management. It aggregates data from the health plan to evaluate program progress, review results and make business decisions via modules.

INDICES also has a customizable dashboard to view tools and online reports with access to historical, current and predictive views of data.

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