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Blues Implement New Software

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BlueCrossBlueShield
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Blue Cross and Blue Shield of Michigan said Monday it had implemented eight software systems from Bowie, Md.-based MedAssurant Inc.

BCBSM will implement systems including CMS 5 Star Complete Quality Management, NCQA HEDIS management, Prospective Advantage, Capitated Risk Adjustment, Claims Aggregation Analysis and Submission, CareSync Advantage, Business Intelligence, and Distributed Analytics.

MedAssurant says the systems will give BCBSM with capabilities to drive initiatives focused on quality, utilization, and financial efficiency to improve care for BCBSM’s Medicare Advantage beneficiaries.

“At Blue Cross Blue Shield of Michigan, we strive to improve the health of patients across our communities by supporting the highest quality of care and effectively managing costs through innovation and collaboration,” said Mark Owen, BCBSM vice president of federal and individual business. “MedAssurant’s integrated solutions are powerful resources in our focus on clinical, quality and financial outcomes for the ultimate benefit of the member — while also decreasing the inefficiencies that can occur with disparate systems.”

Added MedAssurant president and CEO Keith Dunleavy M.D.: “The pressure on plans to deliver superior care and enhance their financial performance continues to increase in today’s health care reform environment. Blue Cross Blue Shield of Michigan is an excellent example of an organization with clear focus on these priorities. The personnel at Blue Cross Blue Shield of Michigan are highly advanced in their understanding of what can drive improvement and efficiency across large health systems. With their partnership, MedAssurant’s integrated systems allow for one coordinated data feed to replace disparate systems, coordinated in-market communication to reduce inefficiencies in care, and integrated analytics to bring the right message to the right member at the right time and place — improving success and minimizing frustration and waste.”

The MedAssurant and BCBSM relationship dates back to 2008 when MedAssurant began coordinating clinical data accuracy and claims analytics for BCBSM’s Medicare Advantage lines of business.

MedAssurant’s CQM enables health plans to better understand and meaningfully improve their CMS 5 Star ratings by leveraging the nation’s largest healthcare quality measurement system and nationwide clinical operations infrastructure to provide deep, dynamically updated insight into clinical quality outcomes and highly sophisticated gap closure mapping to enable health plans to better understand and meaningfully improve their CMS 5 Star and NCQA HEDIS ratings effectively and efficiently – end-to-end.

Prospective Advantage uses predictive analytics to identify assessment, documentation, and care consideration gaps needing attention to proactively improve on quality, utilization, and risk score accuracy.

MedAssurant’s Business Intelligence platform leverages OLAP cube technology and customized pre-calculated analytics to enable healthcare organizations near-real-time insight into member, provider, and clinical facility care, utilization, disease, demographic, and financial trends and performance.

Distributed Analytics provides an industry-leading analytical platform with access to the entirety of a healthcare organization’s data assets, bringing together meaningful data with powerful analytics in an environment friendly to non-technical personnel to enable deep investigation into root cause, improvement, and reporting strategies.

MedAssurant’s comprehensive HEDIS services provide NCQA-certified administrative data analytics and coordinated hybrid medical record abstraction and reporting for CMS, NCQA, and state-specific quality programs and requirements.

CareSync Advantage enables data-driven coordination between disparate care management and intervention programs so that inefficient overlap is eliminated, individual program performance becomes transparent, inter-program direct referrals are enabled, and member-level detail is appropriately accessible to drive program selection decisions.

CARA is the industry’s leading risk score data accuracy improvement solution for risk adjusted Medicare and Medicaid programs.

CAAS provides claims data analysis and formatting for submission by risk adjusted healthcare systems.  

More at www.bcbsm.com and www.medassurant.com.

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