Health insurer leverages clinical data assets to improve care quality and manage commercial risk
“By combining claims and clinical data, we enable providers to better understand a patient’s health issues in real time,” says Colt Courtright, Director of Corporate Data and Analytics at Premera. “For example, a doctor knows what prescriptions have been written, but not if they have been filled. Combining clinical and claims data in real time fills that gap and gives doctors a much more complete picture of their patients’ health, empowering a richer care experience.”
Premera and InterSystems began their initial partnership in 2017, when they used HealthShare to connect to the Alaska health information exchange, healtheconnect Alaska, to bring in 150,000 patient records from across the state. After rapidly achieving a series of milestones through HealthShare’s real-time data access, Premera expanded the services to add its Washington-based customers, and then later to 11 other states. To date, Premera receives Inpatient and Emergency Department (ED) alerts from contracted data sources across these 11 U.S. states from more than 400 EMRs driving efficient and holistic care to its customers.
“We are only scratching the surface when it comes to utilizing Big Data to its full potential in healthcare. We are working with InterSystems as part of Premera’s strategy to leverage data in a meaningful way that provide direct benefits for our customers,” Courtright said. “Since implementing HealthShare, Premera has the potential to better evaluate health risk, and support patients with higher-level care needs.”
“We submit claims every year to CMS that demonstrate the risk we’ve taken on based on our customer population,” said Courtright. “Increased insight into a customer’s complete health picture, and the ability to manage risk in real-time, we believe will prove to be invaluable to our organization.”
“Disconnects between providers and patients have been, and will continue to be, a huge pain point in our healthcare system,” said Don Woodlock, vice president of HealthShare at InterSystems. “Bringing together clinical and claims data provides Premera greater insight into their customers and allows them to innovate in new and exciting ways. This allows them to be better partners and collaborators with their network of providers which leads to better outcomes for everyone.”
InterSystems is the engine behind the world’s most important applications. In health care, finance, government, and other sectors where lives and livelihoods are at stake, InterSystems is the power behind what matters. Founded in 1978, InterSystems is a privately held company headquartered in Cambridge, Massachusetts (USA), with offices worldwide, and its software products are used daily by millions of people in more than 80 countries. For more information, visit InterSystems.com.
About Premera Blue Cross
Premera Blue Cross, a not-for-profit, independent licensee of the Blue Cross Blue Shield Association based in Mountlake Terrace, Wash., is a leading health plan in the Pacific Northwest, providing comprehensive health benefits and tailored services to approximately 2 million people, from individuals to Fortune 100 companies.
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