November 2017
Operational Effectiveness: Better and Faster Ways to Do Business Together
How can we help providers so they can effectively drive operational and clinical efficiencies while continuing to deliver quality care? Blue Cross and Blue Shield of Texas (BCBSTX) is committed to making system and process improvements and innovations to better support and collaborate with providers. Now more than ever, collaboration is essential to help control rising health care costs, avoid redundant or unnecessary care, identify opportunities for members to get the right care at the right time and place, and streamline administrative work. Ultimately, we want to make it easier for providers to do business with us and we want to continue to earn their satisfaction.
In the months ahead, we are rolling out new ways to work together, which have been created with efficiency and effectiveness in mind. As we systematically deploy new processes and programs, we are helping providers realize the ability to integrate these new efficiencies into existing workflows with relative ease.
We are introducing more ways to transact provider-payer business electronically with an increased emphasis on online forms, tools and other resources. The increased focus on electronic tools will help improve data accuracy, which in turn helps ensure claims process accurately and provider directories are up-to-date.
Clinical Data Exchange (CDE) Tool
Another way we are building efficiencies into the provider-payer relationship is through various data solutions that will offer providers greater insight into our members’ health status, and the quality and cost of care they deliver. New CDE tool capabilities will streamline and speed the online exchange of member clinical data between providers and BCBSTX in a scalable and secure platform.
This technology will enable connected providers to access a member’s medical record and the health summary at the site of service. We anticipate this will help providers identify unmet care needs and avoid unnecessary or redundant services. We also anticipate that CDE will help reduce claims processing and payment time as a likely result of fewer pended, denied and appealed claims.
Provider Performance Analytics and Reporting Tool
Care quality and cost analytics and reporting augment our clinical data exchange efforts. We are striving to make the health care system work better through the controlled deployment of a single, online platform for a suite of quality and efficiency analytics and reporting. Our new Provider Performance Analytics and Reporting tool is accessible in the BCBSTX-branded Payer Spaces section to registered AvailityTM Web Portal administrators and assigned users.
This tool offers a robust suite of data dashboards that display valuable information about providers’ overall BCBSTX member population and allows users to filter quality data in a variety of ways such as age range, diagnosis type and contract type. Providers can view emergency room and pharmacy risk adjustment and incentive data, among other details. Our reporting tools can help illuminate the services that may help providers maximize reimbursement.
In addition, provider performance efficiency analytics offer insight into the cost of care by type of care episode and how it compares to care delivered by peer providers in the same market, specialty or network for similar BCBSTX members. This new platform will allow us to deliver reports faster and with dynamic reporting capability.
As Executive Director of BCBSTX’s Quality and Accreditation, Terri Kitchen shares, “With so many different types of performance management metrics available through the dashboards, depending on what the end user needs, there’s probably a dashboard for that.” We believe that the quality and efficiency data will help providers identify and prioritize practice enhancement opportunities.
To prepare for the use of these new data solutions, we encourage you to become a registered Availity user today at no charge. Becoming a registered Availity user will give you immediate access to many tools and resources that are available now, while also ensuring you will be first in line to begin using new data solutions when they launch.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.