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Management Strategies

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Capital BlueCross Unites Analytics and IT Under New CIO Mark Caron

The health insurance veteran speaks to Insurance & Technology about the opportunities to improve care by using predictive modeling and other informatics.

Mark Caron was recently appointed SVP and CIO of Capital BlueCross (CBC, Harrisburg, Pa.), replacing Kent Whiting. He spoke to I&T about how analytics is shaping the health technology landscape.

Insurance & Technology: Tell us a little about your background and how you came to Capital BlueCross.

Mark Caron: I joined the company in June from OptumHealth, a division of UnitedHealth Group. They're focused mainly on care delivery; I was in a business unit called collaborative care. But I've been on the payer side: I was a CIO at Blue Cross and Blue Shield of Massachusetts from early 1997 to the end of 2001, where I worked with Gary St. Hilaire, president of Capital BlueCross. We also worked together at Healthsource. I also worked at Wisconsin BCBS up until its acquisition by Wellpoint.

I&T: How will the CBC IT department be different under your leadership?

MC: It's a new role, reporting to the president of the company, that includes analytics and reporting in addition to IT. So I have all the reporting demands and analytical demands and teams under me as well. I'm still assessing the [analytics] organization. The teams were pretty siloed in different business units, so we're creating a center of excellence and a pooled model that will allow us to better share our resources. It's not only a change in how we do business internally, but also in how we interact with external customers.

I&T: Why put that directly on IT's plate?

MC: Along with healthcare reform, there's been an advent of accountable care agreements and organizations really helping physicians and members understand not just the cost but also the quality of the care. That is heavily analytics- and informatics-driven. It's logical to have the analytics team marrying into the IT organization because of the need to drive more real-time information. That has a real significant impact to it infrastructure, data warehousing tools and platforms and user interfaces and media through which they are delivered to the patient or doctor.

I&T: Are there other changes on the way?

MC: I have not done a lot of restructuring in the IT department. That's partially because we are in the midst of developing a business strategy around medical value [and] a strategic IT plan to enable success. That will require an enterprise architecture we don't have today.

I&T: Can you explain what medical value means in the context of CBC's strategy, and why it's a focus area for the company? How does your increased focus on analytics tie into this?

MC: It's lowering costs while improving outcomes and member satisfaction. The old days of the traditional payer model is gone. If you look at what's happened with physician groups being acquired by payers [and/or] being merged into hospitals, it's a changing environment. We need to meet the demands that reform is driving on the payer side. What failed us in the past as an industry as well as a country is that we were getting information to doctors and patients too late. To meet the demand for behavioral change — to ensure that patients are getting the best care and physicians are making the best decision — we need to get them informatics in real time, whether it's what drugs to use, or what protocol to use. As we evolve our analytical capabilities, we'll be using predictive modeling tools to identify populations that are, for example, at risk for diabetes or potential CF patients.

I&T: It seems like you're not just talking about health insurance systems, but also the broader topic of health IT. What's in it for payers to get so involved in getting systems set up on the provider side?

MC: We can help demonstrate value of health IT. Having worked for a big healthcare system, I understand the capital demand that it takes to build these pools. Payers have by and large had the data — albeit mostly claim data — but we are in the best position to develop these tools and are evolving to include the clinical data out of an EMR. As we incorporate health information exchanges throughout the country, we'll be driving that information to physicians. Some people may think the goals are high, but I think that's the best promise for our country.

Nathan Golia is senior editor of Insurance & Technology. He joined the publication in 2010 as associate editor and covers all aspects of the nexus between insurance and information technology, including mobility, distribution, core systems, customer interaction, and risk ... View Full Bio

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