Updated March 25 at 6:25am

BCBSRI, UnitedHealthcare taking actions to improve health care, lower costs

Blue Cross & Blue Shield of Rhode Island and UnitedHealthcare are taking actions to provide pioneering health initiatives that will lead to improved health, more efficient care and lower health care costs.

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BCBSRI, UnitedHealthcare taking actions to improve health care, lower costs

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PROVIDENCE – Blue Cross & Blue Shield of Rhode Island and UnitedHealthcare are taking actions to provide pioneering health initiatives that will lead to improved health, more efficient care and lower health care costs.

BCBSRI on Monday announced that is has launched an analytics tool to support employers’ efforts to design effective health plans that incorporate workforce wellness that will lead to lower health care costs. This new tool, part of BCBSRI’s Blue Insights health data platform, provides customized reports to employers on their employees’ use of the health care system as well as their health care needs. With that information, BCBSRI asserts, employers can make more informed health insurance plans for their employee population.

“This innovative resource furthers our goal of addressing health care affordability by offering employers a tool to better respond to their employees’ health and wellness needs,” BCBSRI President and CEO Kim Keck said in the statement. “With information at their fingertips…, employers can feel more confident about structuring a health plan that offers choices and the opportunity for employees to become more engaged in planning their care.”

Developed with MedeAnalytics, the employer-reporting tool is a web-based application that measures and visualizes enrollment, utilization, financial and plan performance to create plan designs.

Highly customizable, the tool offers automated reports that can track medical, dental, pharmacy and vision data including: network performance, inpatient and outpatient analysis and

the total cost of care, BCBSRI reported. Blue Insights gives the same data to providers, employers, brokers and health plans; employers may choose to update their plan design at renewal to include lower cost network products, consumer-directed plans or increased incentives for wellness. Group customers with more than 100 covered employees and their brokers or consultants will have access to the data at no additional cost.

In other news, UnitedHealthcare reported that it has selected Coastal Medical of Rhode Island, an accountable care organization, as its local in-network care provider for NexusACO, which is a new health benefits option being offered in more than a dozen markets around the country. NexusACO offers plan participants – self-funded employers with 100 or more employees – access to highly accomplished care providers who have consistently delivered quality and efficient care, UnitedHealthcare reported in a recent release.

“Rhode Island employers want their employees to be able to choose high-performing physicians who have a proven track record of improving patients’ health. NexusACO offers a solution to this need, while making it simpler for patients to receive coordinated care,” UnitedHealthcare CEO Stephen Farrell said in the statement. “We welcome the opportunity to work with Coastal Medical to offer plan participants a more satisfying overall experience, at a great value.”

UnitedHealthcare reported that NexusACO offers these benefits:

  • Better care coordination: A recent United Healthcare evaluation of ACO performance found that the top 10 percent of ACOs supported patients with 75 percent of their health care needs, in contrast with non-ACOs addressing 56 percent of such needs.

  • Better health outcomes: ACO organizations perform better than non-ACOs on 83 percent of UnitedHealthcare’s most common quality measures, according to UnitedHealthcare.

  • Lower costs for higher-quality care: Employers opting to use NexusACO may achieve health care cost savings, as the plan encourages employees to use in-network Tier I care providers to coordinate their care.

Other health care entities have also moved to address health care costs through technology. In February 2013, Providence Business News reported that Lifespan was investing more than $100 million over four years to build a new patient-centric model of care, the center of which was a new health IT platform being built around the Epic software system. The same story reported that, by using NextGen software, Blackstone Valley Community Health Center was able to realize savings of $5 million for its approximately 11,000 patients in 2011.

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