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Traditionally, a physician relies on information the patient provides during an office visit or on reports about diagnostic tests conducted by another doctor to find out whether patients have had recommended health services. But if critical information is not reported during the visit, or if the patient is unaware that he or she is late for a test, the doctor may not be aware of the need for a preventive screening or other test. That's when a gap in care might occur.
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"Clinical Alerts will help physicians avoid these gaps. This is important since studies show that people get recommended care only half the time," says I. Steven Udvarhelyi, M.D., senior vice president and chief medical officer for Independence Blue Cross. "As the leading health plan in the region, we believe Clinical Alerts are an important step toward improving the health of our members by increasing the quality of care, which ultimately helps reduce medical costs."
To create Clinical Alerts, IBC leverages its database of claims information from physicians, hospitals, labs, and pharmacies and identifies care opportunities for its members. Physicians in the Greater Philadelphia region can view the alerts in their offices when prepping for upcoming appointments. IBC began sending alerts in April to physicians through its secure health care provider web portal, which is administered by NaviNet, the country's largest real-time health care communications network for health plans. To date, more than 12,000 of IBC and its subsidiaries' network physicians received over 100,000 Clinical Alerts.
"As a physician, I'm glad that IBC is offering this important service," says Dr. Thomas F. Lyon of Mt. Airy Family Practice. "It is a testament to how the industry can use today's technology to improve patient care by giving me timely, actionable information about my patients."
Clinical Alerts in Action
Picture this. Mary, a 52-year-old woman who hasn't seen her doctor for several years, schedules an appointment because she has severe, flu-like symptoms. Before the appointment, Mary's doctor checks NaviNet to verify her health benefits information and notices a warning flag in her file signaling that a Clinical Alert is available. The Clinical Alert indicates Mary has not had a recommended mammogram. Because of the alert, Mary's doctor not only addresses her flu-like symptoms, but also reminds her about the importance of mammograms for women in her age group.
In addition to alerts about mammograms and cholesterol tests, doctors currently receive several important alerts, based on clinical guidelines, about:
Expanding its prevention and wellness efforts is a key business strategy for IBC, including a commitment to using information technology innovatively to deliver preventive care in new, electronically connected, lower-cost ways. Clinical Alerts is the latest new service that supports prevention and wellness. IBC's strategy is in line with the national trend in the health insurance industry toward expanding preventive care and health information technology. Leveraging and expanding the use of health information technology to improve the quality of care is also a key part of federal health care reform proposals presented by Congressional leaders.
"We strongly support investing in tools and resources that enable us to partner with our physicians to provide even higher quality and more efficient health care for our members," says Dr. Udvarhelyi. "Clinical Alerts are a win-win situation for everyone. So far, the reaction from physicians has been enthusiastic. Clinical Alerts give physicians one more way to connect the dots between health care information and good health, especially when they are encouraging their patients to follow through on preventive measures. Employers also stand to gain since unattended care often results in increased absenteeism, lost productivity and more expensive treatments down the road."
Clinical Alerts grew from IBC's ability to analyze, sort, and prioritize critical health information about its members for physicians' use. The service also extends IBC's existing online services for physicians, such as tools to automate office paperwork and twice-yearly SMART((R) )Registry reports. Like a sports team, physician practices like to see how they measure up against their peers, or competition. With the SMART Registry, doctors can see how their performance compares to other local practices on key clinical indicators when tracking the health status of patients with chronic conditions such as diabetes, coronary heart disease, asthma, or chronic obstructive pulmonary disease. These tools make it convenient for physicians to use this data with their patients so that members have an even greater awareness and understanding about their condition, possible health risks, and the preventive measures that can help them stay healthy.
Clinical Alerts are available to primary care providers, OB/GYNS, endocrinologists, and cardiologists. IBC plans to expand Clinical Alerts to include additional specialists and alerts on other topics in the near future.
About Independence Blue Cross
Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. Nationwide, Independence Blue Cross and its affiliates provide coverage to nearly 3.4 million people. For more than 70 years, Independence Blue Cross has offered high-quality health care coverage tailored to meet the changing needs of members, employers, and health care professionals. Independence Blue Cross's HMO and PPO health care plans have consistently received the highest ratings from the National Committee for Quality Assurance.
Independence Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
-- eye exams for patients with diabetes; -- colorectal cancer screenings for patients age 51 to 75; -- ongoing beta-blocker treatments for patients who have had heart attacks; -- cholesterol tests for patients with diabetes or cardiovascular conditions; -- cervical cancer screenings; -- kidney tests for patients with diabetes.
SOURCE Independence Blue Cross
