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Three years ago this month, BlueCross BlueShield of Tennessee announced a health information technology initiative with the state of Tennessee that was, in many ways, unlike any other in the country. Called Shared Health, the idea was to create a health record for patients across multiple providers, thus reducing medical errors, avoiding duplicate services and even detecting fraud and abuse. The idea was a good one, and it worked. A fully-owned BlueCross subsidiary, Shared Health initially launched what it called its “patient-centered community health record” to include BlueCross’ TennCare members. Today, Shared Health electronically tracks the health of all TennCare members and enrollees of BlueCross commercial groups in Tennessee, as well as Nissan North America employees. That’s a total of about 2 million lives, and the number is growing, according to Shared Health’s Chief Medical Officer, Bruce Taffel, MD. He anticipates some 500,000 additional enrollees of BlueCross self-insured accounts will soon be added to the roster. In addition, Shared Health is involved in “some interesting discussions” with the state to add itsemployees and with the federal Centers for Medicare and Medicaid Services to add Tennesseans on Medicare. Effectiveness by the Numbers Late last year, Shared Health announced results of a study that concluded that its electronically available health records improved the efficiency of healthcare delivery for several specific diseases by 17 percent. “We focused in on 102 practices. We looked at how they were treating patients, what was happening with their treatment prior to using Shared Health and then during the time they were (using Shared Health),” Taffel explained. “We looked at the same practice with the same patients and the same disease states. This is as good a control as you can get.” The study tracked costs across a broad range – physician evaluations, hospital stays, pharmacy, lab, imaging, surgery and much more — and concluded that when the right hand knows what the left hand is doing, workflow is improved and duplication of services is avoided. There’s some evidence as well that a medical record of a patient shared among clinicians also improves patient health. “We’ve been following compliance with evidence-based guidelines for wellness care in the Shared Health population versus non-Shared Health population. We’ve found that the compliance is much higher,” Taffel said, adding that a new data-exchange platform to be implemented by Shared Health beginning this month will allow easier tracking of health outcomes. “We think what we’re going to see is efficiency and quality going hand-in-hand,” he said. “A Remarkable Upgrade” Shared Health announced last month its first major system upgrade, dubbed the Shared Health Clinical Xchange. Taffel called it a retooling “from the ground up” and “a remarkable upgrade. Doctors will find much greater functionality … directly contributing to quality of care.” Brian Young, Shared Health’s clinical product manager, said the upgrade will be particularly valuable to physicians as they treat patients with chronic diseases. One feature will present a “problem list” for physicians who are seeing a patient for the first time, while another will prompt doctors with the latest evidence-based medicine guidelines. The system will “serve more as a memory jogger more than anything when a patient presents in the office. Everything that we’re trying to do from a product standpoint is to be a trusted source for clinicians and improve outcomes,” Young said. Both Young and Taffel touted the new system’s open format, which allows physicians to add patients who aren’t members by virtue of their third-party payer. While today patients in the system must be TennCare, BlueCross or Nissan, once the upgrade is in place, a doctor may key in information on any patient who might benefit from a health record accessible to numerous clinicians. “This will be really great,” Taffel said. “It will allow a physician to say, ‘Mrs. Jones isn’t in your database, but I think it would be really valuable for me to be able to track her care using these tools and make this information available on the network.’” Taffel said he believes the add-a-patient feature “will compel some of the other payers to come onboard.” The Future BlueCross initially contributed $25 million over three years to establish Shared Health. After the first year, the state was charged based on the number of TennCare enrollees. The same for other BlueCross plans and Nissan. Already, the initiative is “self-sustaining,” Taffel said. Nissan just completed its two-year trial period, and the two entities are in discussions for the contract continuation. “The bottom line is that we’re tracking results, which is real important. You just can’t throw this out there. You’ve got to be able to look at how you’re doing, and we’re making every concerted effort for case studies, to go back and look at the effects,” Taffel said. That will lure more lives into the database, he noted. What’s next? Shared Health is in the throes of launching a new study with Brigham and Women’s Hospital, a teaching affiliate of Harvard University, and the University of Alabama at Birmingham to investigate the impact of Shared Health on quality, cost and physician satisfaction. Taffel said the study “is getting some real national notice” because of the emphasis on doctors’ adoption of health information technology. “We think this is important information, to understand what the barriers are for adoption and how to reduce those barriers,” he said. Then he added a word of wisdom regarding HIT adoption: “You’ve got to have a lot of patience in health information technology. It’s very hard to get immediate success. It is a slow curve, but we’re anticipating that as we and as the industry mature and recognition increases — and particularly as users begin to see more and more value — that the use is going to grow exponentially.” July 2008

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