BCBSMA Industry Collaboration

May 2006


Blue Cross Blue Shield of Massachusetts (BCBSMA) has a number of collaborative initiatives underway with providers and the health care industry to support your efforts to deliver excellent care to your patients. Here is a summary of some of our collaborative initiatives underway.

eRx Collaborative

Prescribers participating in the eRx Collaborative have transmitted more than three million electronic prescriptions. Formed in 2003, the eRx Collaborative includes BCBSMA, Tufts Health Plan, Neighborhood Health Plan, and technology vendors Zix Corporation and DrFirst. Within just two years, this Massachusetts e-prescribing program has achieved the nation's highest adoption and utilization rates. As of year-end of 2005, the eRx Collaborative has:
  • Achieved the goal of maintaining 3,400 deployed users.
  • Improved patient safety through alerts to potentially harmful drug-drug and drug-allergy interactions. More than 4,000 potentially harmful prescriptions were cancelled each month as a result of these alerts.
  • Created efficiencies in care by reducing calls from pharmacies and chart pulls. In addition, prescribers can react proactively to Food and Drug Administration safety warnings about specific drugs by generating reports listing all their patients taking the medication.
  • Helped to make health care more affordable. BCBSMA data shows that e-prescribers used the Plan's formulary drugs more than non-e-prescribers, resulting in a 1.5% drug cost savings on new prescriptions and subsequent refills. Members whose providers change their prescription to a lower tier drug can save an average of $20 to $25 per prescription.
Health Information Technology Award

BCBSMA was recently awarded America's Health Insurance Plans' 2006 Innovation and Excellence Award for Health Information Technology. Our entry, "Meeting the Challenge to Transform Health Care," focused on our programs that encourage and support providers to adopt information technologies in their practices. The award recognizes BCBSMA's collaborative efforts in providing leadership, direction, and financial and human resources for this critical challenge. One part of this commitment is to work with providers to speed the pace of implementing electronic technologies. Our vision is a health care system that provides safe, timely, effective, affordable, patient-centered care for everyone in Massachusetts. Our application for the award examined BCBSMA's multi-pronged approach to this complex problem. The company has joined forces with other health care system participants, including our direct competitors, on longer-term projects such as the Massachusetts eHealth Collaborative and the eRx Collaborative, to jump-start the use of health care information technology.

Electronic Medical Records (EMR) Medical Decision Support Pilots

BCBSMA has several pilot projects underway to replace paper-based medical records with EMR coupled with medical decision support (MDS) tools. This combination will help providers make clinically appropriate diagnostic and treatment decisions, avoid potential medical errors, and reduce costs by providing the latest evidence-based medicine protocols to physicians at the point of care. We are working with medical decision support vendor SafeMed and the following EMR vendors - NextGen, eClinicalWorks, Integrated HealthWare, and GE Medical to provide the technology for these initiatives.

Common Credentialing Initiative (HCAS)
Lori Burgiel was recently named Executive Director of Health Care Administrative Services, Inc. (HCAS), the new non-profit entity created to simplify redundant administrative tasks across health plans. Ms. Burgiel was most recently the Senior Director of Managed Care Policy for the Massachusetts Hospital Association. Seven Massachusetts health plans participate in HCAS, which is currently working to help providers and health plans centralize and streamline the credentialing and recredentialing processes. The first phase of recredentialing for participating health plan providers begins in September 2006. The HCAS process will allow providers to complete the process once for several health plans while ensuring accuracy, timeliness and security of the process. In September 2006, HCAS will begin recredentialing for in-state physicians. In October, 2006 HCAS will perform initial credentialing for all providers and recredentialing for out-of-state and ancillary providers. For more information, visit www.hcasma.org

National Provider Identifier (NPI)

All providers must begin using their NPI, a unique health care provider identification number, by May 23, 2007, according to federal regulations. BCBSMA is collaborating with the Massachusetts Health Data Consortium to coordinate NPI communications and information to all providers. BCBSMA is working now with complex provider organizations (CPOs), such as hospitals, physician organizations, and large group practices, to review their current BCBSMA legacy provider number structure. BCBSMA Provider and Ancillary Provider Relations Managers are meeting with CPOs starting during Q2 2006 to review their proposed NPI structure and ensure they understand how NPI structure may impact their business. Internally, the NPI workgroups are finalizing the analysis of the NPI project and evaluating vendors to develop a centralized crosswalk solution to transition from legacy numbers to NPIs.