Selina Loupe is Director, Clinical Partnerships at Blue Cross and Blue Shield of Louisiana. Selina led the development and implementation, and currently manages the operations for Quality Blue Primary Care (QBPC), an enhanced population health and quality improvement program. She is leading the provider engagement care transformation team as they recruit practices and expand Quality Blue Primary Care statewide throughout Louisiana. Selina will be a featured panelist on the Data Governance panel of the Chilmark Convergence conference in Boston, Oct 4-6, where she will speak about how Blue Cross is working with providers to improve care quality and reduce costs while measuring health improvement.
How is your organization beginning to focus on convergence with providers?
For the past four years, we have been conducting a quality program with providers based on the tenets of a patient centered medical home (PCMH). We have been focusing on the major chronic conditions, such as diabetes – in our state, more than two-thirds of adults have at least one chronic condition, so managing these well can have a major impact on health outcomes and costs.
In this program, we provide clinicians (at no charge) with a data aggregation tool (from SPH Analytics) that brings together a wide source of information. This includes plan data such as claims, lab results, pharmacy claims, and clinical information from providers’ EMRs. The tool provides a Patient Care Summary highlighting the status of critical health measures and gaps in care. Clinicians can view the information for their patients at the point-of-care to make better clinical decisions. The information is in as near as real-time as available, – which (depending on the data) can include daily or weekly updates from data sources.
We measure for optimal managed control rate, which is a composite score of multiple measures. For diabetes, for example, this requires all four of the measures to be in the control range – blood sugar level, blood pressure, LDL reading, AND must be a non-smoker. In all, there are more than 200 measures available to clinicians.
Maintaining data integrity is a key challenge – the aggregation tool provides the source of the data used in the measure…Primary care providers often have not seen holistic patient care status with well-aggregated clinical EMR and payer claims data.
What data can and should be shared and among whom when it comes to convergence?
We use a patient attribution process, which determines what data gets shared and with whom. All providers participating in the QBPC program have access to the population health management tool and the Patient Care Summaries. Clinicians other than the attributed physician have to answer five demographic questions to have access to a patient’s data in the aggregation tool. One unique aspect of our program is that the data aggregated in the tool can include patients who are not members of Blue Cross. The tool is offered for use and it can include patient information for the provider’s entire practice. Of course, Blue Cross network clinicians are limited to access only their Blue Cross patients. There are more than 65 EMRs in use in the state – to help enable access, we’ve already integrated data from 19 of the largest EHRs like Cerner and Epic.
Have you seen outcomes improve?
Yes, with this program we’ve seen tremendous success. There is just such an advantage to everyone on the care delivery team using the same aggregated clinical data. You may have heard that Louisiana is ranked 49th in the nation when it comes to health care (according to the 2016 Trust for America’s Health rankings), so about the only direction we can go is up. When you have access to clinical outcomes data, the care delivery team is able to focus on those most in need of interventions. The QBPC program is groundbreaking in the state.
How are you handling patient consent?
The program operates on an opt-out model – we’re required to notify patients that their data is being shared. We use a welcome letter when the patient is first included in the program that describes his/her options, as well as an annual privacy statement. We’ve been impressed with the level of patient engagement, but it is dependent on ensuring we communicate with the patients the way they want to be contacted. For example, some don’t want to be called when they are home. Our masking of certain protected information such as protected diagnoses and chemical dependencies also goes a long way to gaining a patient’s engagement and trust.
What are some of the challenges with governance of convergence that you are seeing?
Maintaining data integrity is a key challenge – the aggregation tool provides the source of the data used in the measure. For example, where and when a blood pressure reading was recorded. Primary care providers often have not seen holistic patient care status with well-aggregated clinical EMR and payer claims data. Maintaining data integrity is a critical tenet of the QBPC program, as it is the source of truth for performance measurement and is a factor in the provider payments. We work to ensure the practice improves processes to accurately capture and record the clinical data in the EMR all the way through ensuring the right information makes it into the tool.
Anything else you would like to add or stress?
As the oldest and largest private insurer in the state, we are collaborating with Louisiana’s most significant providers and meeting with public health groups to work out how we collectively tackle even broader issues of healthcare on a statewide basis. Our experience with working with providers, of aggregating clinical EMR and payer claims data, and of working on data quality will all be keys to success.